Today's Dietitian - August 2014

2014
DIABETES
RESOURCE
GUIDE
The Top 10
The Top 10
The Top 10
Gluten-Free
Fast Food
Dairys Probiotic
Prowess
Build Your Career
via Public Speaking
Experts Review US News & World
Reports Highest-Ranked Diets
AADE CONFERENCE ISSUE
www.TodaysDietitian.com
August 2014
Vol. 16 No. 8
The Magazine for Nutrition Professionals
YUM
CHOLESTEROL
FREE
NEW
SCIENTIFIC
STUDIES
8% DV FIBER
PER 1-OZ.
SERVING
NATURALLY
GOOD FATS
Ex: AVOCADO
Id: HASS
W: 232g
Lin: 1/1
Id:BRM/Lin:BRM3/Id:14372
w:1825 L:3244
Ex:2251897
The next time your clients need a fresh source of
naturally good monounsaturated fats, recommend
an avocado. Learn more about avocado nutrition
and see the results of recent avocado studies at
LoveOneToday.com.
naturally good fats cholesterol free
2014 Hass Avocado Board.
All rights reserved.
DATE: 3.17.14 CLIENT: HASS TRIM SIZE: 8" x 10.5" APPROVAL INITIAL/DATE/TIME APPROVAL INITIAL/DATE/TIME
FILE NAME: HAB130410 PREPARED BY: Mollie LIVE SIZE: 7.25 x 10 1 ART DIRECTOR 4 PROD. MGR
PUB/ISSUE: Todays Dietitian April INTERNAL ROUND: R1 BLEED SIZE: +.25" 2 COPYWRITER 5 PROJ. MGR
FILE TYPE: INDD CS CLIENT ROUND: Final LASER SCALE: 100% 3 COPYEDITOR 6 ACCOUNT MGR
NOTES:
HAB140410_HealthProf_Ad_TodaysDietitian_Apr.indd 1 3/17/14 4:08 PM
Client: Domino Job #: DM2013-1253 Ad #: DOM-2171
Media: Todays Dietitian Issue: Aug 14 Ad Size: live: 7.25x10; trim: 8x10.5; bleed: 8.5x11
THIS ADVERTISEMENT PREPARED BY
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Images ItalianTomatoes_HerbedCottageCheese_Toast_InkLimit.psd (CMYK; 577 ppi; 51.93%),
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9468_Ad_TodaysDietation_April_RUN.indd
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Creative Director
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Michael Schultz
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JOB INFO FONTS & IMAGES APPROVAL & NOTES
SAVED 3-18-2014 1:14 PM | BY Mike Schultz | PREVIOUSLY BY Mike Schultz | FILES SENT VIA None Contact Rae Ann Fisch (816) 423-6196 rfisch@barkleyus.com ROUND
References:
1. Leidy HJ, Armstrong CL, Tang M, Mattes RD, Campbell WW: The inuence of higher protein intake and greater eating frequency on appetite control in overweight and obese men. Obesity (Silver Spring) 2010, 18:17251732.
2. Purslow LR, et al. Energy intake at breakfast and weight change: Prospective study of 6,764 middle-aged men and women. American Journal of Epidemiology. 2008;167:188
3. Kant AK, et al. Association of breakfast energy density with diet quality and body mass index in American adults: National Health and Nutrition Examination Surveys, 1999-2004. American Journal of Clinical Nutrition. 2008;88:1396.
to the healthy foods you already recommend.
Add Daisy
DISCOVER THE BENEFITS THAT COME WITH NUTRITION AND TASTE.
Maximize Muscle Synthesis
Encourage your patients and clients to make the
most of their protein consumption. Studies show
that consuming 20 to 30 grams of protein at each
mealinstead of one large meal high in protein
can maximize muscle synthesis, which is critical
for everyone.
1
Stay On Track
Research suggests that when people eat
breakfast, they tend to eat a healthier overall
diet, one that is more nutritious and lower in
fat.
2,3
Part of this means starting the day with
a breakfast high in protein. Daisy Low Fat
Cottage Cheese has 13 grams of satisfying
protein and 4 grams of carbs per 90 calorie
cup serving. A meal high in protein and low
in calories and carbohydrates will promote
satiety and regulate blood sugar levels.
Variety The Spice of Life
Cottage cheese is so convenient and versatile;
you can enjoy it for breakfast, lunch, dinner or a
snack. Pair it with fruits, vegetables, nuts or whole
grains, or use as an ingredient in favorite recipes,
such as lasagna, for a healthier spin. Eating
healthy doesnt need to be complicated or boring.
Power the Day with Daisy
Better Ingredients: Thats the
Daisy Diference
Daisy Low Fat Cottage Cheese is made with
4 high quality ingredientsno additives,
thickeners or preservatives. Look for our new
packaging with colored lids.
S:7.25
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1
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5
B:8.5
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:
1
1
EDITORS SPOT
President & CEO
Kathleen Czermanski
Vice President & COO
Mara E. Honicker
EDITORIAL
Editor Judith Riddle
Editorial Director Jim Knaub
Senior Production Editor Tracy Denninger
Editorial Assistants Heather Hogstrom, Leesha Lentz
Contributing Editor Sharon Palmer, RD
Editorial Advisory Board Dina Aronson, RD; Jenna A. Bell, PhD, RD;
Janet Bond Brill, PhD, RD, CSSD, LDN; Marlisa Brown, MS, RD, CDE, CDN;
Constance Brown-Riggs, MSEd, RD, CDE, CDN;
Carol Meerschaert, MBA, RD; Sharon Palmer, RD;
Christin L. Seher, MS, RD, LD
ART
Art Director Charles Slack
Graphic Designer Erin Prosini
Junior Graphic Designer Victoria Tuturice
ADMINISTRATION
Administrative Manager Helen Bommarito
Administrative Assistants Pat Plumley, Susan Yanulevich
Executive Assistant Matt Czermanski
Systems Manager Jeff Czermanski
Systems Consultant Mike Davey
FINANCE
Director of Finance Jeff Czermanski
CONTINUING EDUCATION
Director of Continuing Education Jack Graham
Continuing Education Editor Kate Jackson
Continuing Education Coordinator Leara Angello
Continuing Education Assistant Susan Graver
CIRCULATION
Circulation Manager Nicole Hunchar
MARKETING AND ADVERTISING
Publisher Mara E. Honicker
Director of Marketing and Digital Media Jason Frenchman
Web Designer/Marketing Assistant Jessica McGurk
Marketing Coordinator Leara Angello
Sales Manager Brian Ohl
Associate Sales Manager Peter J. Burke
Senior Account Executives Sue Aldinger, Gigi Grillot,
Diana Kempster, Beth VanOstenbridge
Account Executives Victor Ciervo, Dan Healey, Patricia McLaughlin
Sales Coordinator Joe Reilly
2014 Great Valley Publishing Company, Inc.
Phone: 610-948-9500 Fax: 610-948-7202
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All articles contained in Todays Dietitian, including letters to
the editor, reviews, and editorials, represent the opinions of the authors,
not those of Great Valley Publishing Company, Inc. or any organizations
with which the authors may be afliated. Great Valley Publishing
Company, Inc., its editors, and its editorial advisors do not assume
responsibility for opinions expressed by the authors or individuals quoted
in the magazine, for the accuracy of material submitted by the authors, or
for any injury to persons or property resulting from reference to ideas or
products discussed in the editorial copy or the advertisements.
Judy
CAN WE ALL GET ALONG?
In June, the Centers for Medicare & Medicaid
Services (CMS) issued a landmark ruling stating
that qualied dietitians or nutrition professionals
may order all patient diets, including therapeutic
diets, in hospitals as authorized by the medical
staff and in accordance with state law.
The ruling doesnt specify which qualied
nutrition professionals may provide the same hospital services
as RDs. However, because the Board for Certication of Nutri-
tion Specialists (BCNS) was instrumental in changing the draft
language in the proposed rule to include all qualied nutrition
professionals, including certied nutrition specialists (CNSs),
RDs have begun scrutinizing the CNS credential.
When Todays Dietitian posted the news about the ruling from
the BCNS on its Facebook wall, comments poured in. A few RDs
supported the ruling, stating that CNSs are just as qualied as
they are. Others rejected the ruling, claiming it undermines and
devalues the RD credential, that it renders the RD degree worth-
less and dietetic internships purposeless. Some commenters
feared for the future of RDs in hospitals.
To obtain the CNS credential, you must have at least a master
of science or doctoral degree in the nutrition or clinical health
eld; complete coursework in nutrition, biochemistry, physiol-
ogy or anatomy/physiology, and the clinical health sciences at
an accredited university; complete 1,000 hours of supervised
practical experience in nutrition; and pass an exam. For the RD
credential, you must have at least a bachelors degree and com-
plete a dietetic internship from an accredited university, com-
plete 1,200 hours of supervised practice experience in nutrition,
and pass an exam.
A CNS requires more education than an RD. However, many
RDs have masters and doctoral degrees plus other specialized
certications. To be sure, RDs have the right to question whether
lesser-qualied nutrition professionals with fewer years of edu-
cation and practice experience should offer the same hospital
services, but should we argue about whos more qualied and
worry about job security or should we simply accept one another
as colleagues and try to get along? Stay tuned for more in-depth
coverage of this controversial ruling in an upcoming issue of
Todays Dietitian.
In light of the American Association of Diabetes Educators
Annual Meeting and Exhibition, this months issue features special
diabetes coverage on US News & World Reports top 10 diets for
patients and strategies for overcoming weight loss challenges.
See you in Orlando!
Judith Riddle
Editor
TDeditor@gvpub.com
august 2014 www.todaysdietitian.com 5
FEATURES
22 The Top 10 Diabetes Meal Patterns Nutrition professionals
review US News & World Reports highest-ranked diets for clients
and patients.
28 Gluten-Free Fast Food Many fast-food chains are offering
gluten-free menus, but there are some important things clients
and patients must know before chowing down.
32 Dairys Probiotic Power Heres a review of the benets of
probiotics, the top sources, and whats new in the dairy case.
38 Building a Career Through Public Speaking RDs discuss
what it takes to get started, how to set goals, and the importance
of choosing a specialty for long-term success.
42 CPE Monthly: Caring for Todays Cancer Survivors
This continuing education course focuses on cancer survivors
nutrition-related issues following the conclusion of active
cancer treatment.
DEPARTMENTS
5 Editors Spot
7 Reader Feedback
8 Ask the Expert
10 Health Matters
12 Conference Currents
14 Dynamics of Diabetes
17 Vegetarian Nutrition
20 Supplement Spotlight
49 Personal Computing
50 Focus on Fitness
52 Get to Know
54 Diabetes Resource Guide
55 News Bites
58 Bookshelf
60 Products + Services
62 Research Briefs
64 Summer Product Showcase
65 Datebook
66 Culinary Corner
CONTENTS
AUGUST 2014
Todays Dietitian (Print ISSN: 1540-4269, Online ISSN: 2169-7906) is published monthly by Great Valley Publishing Company, Inc., 3801 Schuylkill Road, Spring City, PA 19475. Periodicals
postage paid at Spring City, PA, Post Ofce and other mailing ofces. Permission to reprint may be obtained from the publisher. REPRINTS: The Reprint Outsource, Inc.: 877-394-7350
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POSTMASTER: Send address changes to Todays Dietitian, 3801 Schuylkill Road, Spring City, PA 19475. Subscription Rates Domestic: $14.99 per year; Canada: $48 per year; Foreign:
$95 per year; Single issue: $5. Todays Dietitian Volume 16, Number 8.
Page 42
14 32
READER FEEDBACK
From Our Twitter Page
Popular Tweets, Retweets
June Issue
@nutrinotions: Got my new edition! Every article is
spot on. Cant wait to read more!
Men in Dietetics
@DropBarDarcy: As an RD, I appreciated the Mens
Health Month June edition. Male dietitians are on
the up and coming!
Athletes and Protein Intake
@kimsteinRD: You need protein to build/repair
muscle and carbs to fuel. Great article on
protein intake.
@Eat_Pray_Run: Great article on the latest talk
about protein.
Exercise During Pregnancy (Focus on Fitness)
@CuseSportsRD: So important yet so under-
emphasized.
Grilling Tips (Ask the Expert)
@jenhaugen: Great grilling tips, Toby Amidor!
Essential for a safe summer!
@BeefRD: Just in time for summer!
Rising CO
2
Poses Signicant Threat to Human
Nutrition (Research Brief)
@EmmaJaneRD: Great to see impact of increased
CO2 climate change on food production being
raised by Todays Dietitian; risk of micronutrient
deciencies.

From Our Facebook Wall
A Pill for Celiac Disease Is Almost Here
www.hufngtonpost.com
Calli Leigh: I think it would help the accidental harm of gluten
intake for people who have celiac disease. People who think
they have a gluten intolerance might abuse it, though.
Chelsea Johns: While I think it would be incredible for children
with celiac disease to feel they can eat the normal food that
everyone else is eating, Im afraid it may authorize people who
switched to eating nutrient-dense, gluten-free foods (fruits,
veggies, etc) to go back to nutrient-poor foods like sugary
breakfast cereal, prepackaged cookies, etc.
8 Things Nutrition Experts Wish You
Would Stop Saying About Food
www.hufngtonpost.com
Karl n Cheryl Flanagan: Yes! Although I do believe theres a
need for the label bad foods, but it should be given to bad
foodlike substances.
Growing Up on Raw Foods
www.nytimes.com
Susan Macfarlane: The rst thing I would ask is why are you
following a raw diet and whats the message youre trying to
send? As a vegan myself, I completely support families who want
to choose a vegan diet for ethical, environmental, health, or a
combination of the three reasons. However, I think that only eating
raw (which generally excludes all animal products by default) may
lead to a distorted relationship with food, similar to orthorexia. I
do see the benets of consuming some foods in their raw form,
since cooking does destroy heat-sensitive nutrients, however,
cooking also can enhance the nutrition of the food, as is the case
with cooked spinach. I also disagree that a diet that requires
supplementation is inherently unhealthful. Here in Canada, its
difcult to meet our vitamin D requirements, thus essentially
all Canadians require supplementation. This doesnt mean that
whatever diet were following is necessarily unhealthful.
June 2014
Vol. 16 No. 6
CONFERENCE ISSUE
5 Summer
Foodservice
Programs for Kids
Dairys Value in
Disease Prevention
MENS
HEALTH
MONTH
FEATURING
Men in Dietetics
Mens Fitness
INSIDE
Gluten-Free
Showcase
Athletes
Protein
Intake
and
Experts Discuss
Whether the RDA
Is Adequate
S
cientic studies have shown that Almased can help
maintain healthy blood sugar levels as well as the
equally important leptin level. It was also suggested
that Almased can help maintain healthy blood levels for body
compounds such as cholesterol.
Almased is an all-natural powder made from high-
quality non-GMO soy, yogurt and enzyme-rich honey. It is
made in a unique fermentation process, is gluten-free and
rich in essential amino acids. The product does not contain
articial llers, avors, added sugars, preservatives or stim-
ulants. Almased has a low glycemic index (27) and extreme-
ly low glycemic load (4) and is diabetic friendly. The renowned
Joslin Diabetes Center suggests that a carb controlled diet
consists of approximately 40% carbohydrates, 30% fat and
30% protein. The Almased Diet provides this recommended
mix of micronutrients.
The Weight Loss
Phenomenon
with scientic
results
Help your clients succeed with
their weight loss goal
An all-natural weight loss system
which also helps to maintain healthy
blood sugar levels
Catarsha
Atkins lost
75 lbs with
Almased!
before
Read Catarshas
story and more at
www.almased.com.
Order these FREE
brochures for you and
your clients.
Download the Almased Figure
Plan and other brochures
at www.gureplan.com.
Enter Source Code TD1.
You can nd Almased in
health food stores and
nationwide at GNC and
the Vitamin Shoppe.
Ask our nutritionist
We oer comprehensive information
packages for health care professionals
and clients. In addition, our nutritionist
Silke Ullmann, MPH, RD, is available to
assist you and your clients with advice
and more detailed information.
Email her at nutritionist@almased.com.
Todays Dietitian Aug ad_03.indd 1 23.06.14 09:41
TEXT MESSAGING
FOR HEALTH
By Toby Amidor, MS, RD, CDN
Q:
Has texting ever been shown to be an effective nutrition
education tool?
A:
In todays society, cell phones are a mainstream way of
communicating. As such, many are focusing their atten-
tion on the use of texting as a means of providing nutrition
education. Several successful mobile information services
have been designed to promote healthful eating through text
messaging, including Text2BHealthy and Text4baby.
Text2BHealthy
Text2BHealthy was developed by the University of Maryland
Food Supplement Nutrition Education program and implemented
this year in 19 schools across Maryland where more than 2,600
parents enrolled, reaching on average about 25% of the parent
population at participating schools.
Text2BHealthy recognizes that parents play an important
role in the development of their childrens eating patterns and
physical activity. The program provides two targeted messages
per week to parents that act as actionable nudges about how
they can be positive role models by eating healthier foods and
becoming more physically active. Parents also receive nutrition
information that connects what their children have been
learning in the classroom with tips and ideas on implementing
healthful eating behaviors at home. A sample text message
would read, This week is MSA testing week at Barclay
Elementary. Make sure your child eats breakfast. A healthy
start to the day will help them do well in school.
We can educate the kids, but if were not educating their
caregivers who provide for the kids, how likely will changes
be made in the home? says Joni Garcia, MS, RD, program
integrity team lead at the USDA Food and Nutrition Service
Mid-Atlantic Regional Ofce. Text2BHealthy aims to reach this
population and communicate with them in a way that meets the
needs of their busy schedules. It meets them where they are.
Results from the Text2BHealthy evaluation found that
close to 40% of Text2BHealthy parents are eating fruits and
vegetables as snacks more often at the end of the year than
they were at the beginning, and 74% of parents now are eating
fruits and vegetables as snacks often or every day. Moreover,
52% of Text2BHealthy parents report eating two or more
vegetables at their main meal often or every day, and 47%
of parents say their child is doing the same.
Text4baby
Text4baby is a free service offered through National
Healthy Mothers, Healthy Babies Coalition and is supported
and promoted by more than 1,200 health departments,
academic institutions, health plans, businesses, and the
federal government. Participants are sent more than 250
messages containing the most critical information that
experts want pregnant women and moms with infants aged
younger than 12 months to know. Messages address issues
such as breast-feeding, nutrition, exercise, prenatal care,
and oral health. A sample text message for pregnant women
would read, Morning sickness may be caused by a change in
your hormones. Try eating crackers or dry cereal. Eat small
meals often. Dont go without eating.
An evaluation of the Text4baby program found that 74% of
total respondents said Text4baby messages informed them
of medical warning signs they didnt know.
1
Future of Nutrition Education
With texting and cell phones being the major means of
communication, nutrition professionals need to evolve their
education techniques to meet with modern times. Texting and
other nontraditional ways of providing information, such as
social media, is the future of communication and education,
Garcia says. Nutrition professionals working with the public
need to be exploring these avenues for providing information
because thats our future.
Toby Amidor, MS, RD, CDN,
is the founder of Toby Amidor Nutrition
(http://tobyamidornutrition.com) and
the author of the cookbook The Greek
Yogurt Kitchen. Shes also a nutrition
expert for FoodNetwork.com and
contributor to US News Eat + Run.
Reference
1. Hoff A, Nunez-Alvarez A, Martinez KM, Lacoursiere DY.
Maternal and newborn health: Text4baby San Diego evaluation
overview: October 2011-October 2012.
ASK THE EXPERT
Have questions about nutrition trends, patient care,
and other dietetics issues youd like to ask our expert?
Send your questions to Ask the Expert at TDeditor@gvpub.com
or send a tweet to @tobyamidor.
8 todays dietitian august 2014
S
cientic studies have shown that Almased can help
maintain healthy blood sugar levels as well as the
equally important leptin level. It was also suggested
that Almased can help maintain healthy blood levels for body
compounds such as cholesterol.
Almased is an all-natural powder made from high-
quality non-GMO soy, yogurt and enzyme-rich honey. It is
made in a unique fermentation process, is gluten-free and
rich in essential amino acids. The product does not contain
articial llers, avors, added sugars, preservatives or stim-
ulants. Almased has a low glycemic index (27) and extreme-
ly low glycemic load (4) and is diabetic friendly. The renowned
Joslin Diabetes Center suggests that a carb controlled diet
consists of approximately 40% carbohydrates, 30% fat and
30% protein. The Almased Diet provides this recommended
mix of micronutrients.
The Weight Loss
Phenomenon
with scientic
results
Help your clients succeed with
their weight loss goal
An all-natural weight loss system
which also helps to maintain healthy
blood sugar levels
Catarsha
Atkins lost
75 lbs with
Almased!
before
Read Catarshas
story and more at
www.almased.com.
Order these FREE
brochures for you and
your clients.
Download the Almased Figure
Plan and other brochures
at www.gureplan.com.
Enter Source Code TD1.
You can nd Almased in
health food stores and
nationwide at GNC and
the Vitamin Shoppe.
Ask our nutritionist
We oer comprehensive information
packages for health care professionals
and clients. In addition, our nutritionist
Silke Ullmann, MPH, RD, is available to
assist you and your clients with advice
and more detailed information.
Email her at nutritionist@almased.com.
Todays Dietitian Aug ad_03.indd 1 23.06.14 09:41
Sponsored Content
Fish Oil May Benet
Those Who Abuse Alcohol
Omega-3 sh oil may help protect against alcohol-related neuro-
damage and the risk of eventual dementia, according to a study pub-
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Many human studies have shown that long-term alcohol abuse causes
brain damage and increases the risk of dementia. The new study found
that in brain cells exposed to high levels of alcohol, a sh oil compound
protected against inammation and neuronal cell death.
The study was conducted by Michael A. Collins, PhD; Edward J.
Neafsey, PhD; colleagues at Loyola University Chicago Stritch School
of Medicine; and collaborators at the University of Kentucky and the
National Institute on Alcohol Abuse and Alcoholism.
Collins and colleagues exposed cultures of adult rat brain cells over
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the legal limit for drivinga concentration seen
in chronic alcoholics. These brain cultures were
compared with cultures exposed to the same high
levels of alcohol, plus DHA. Researchers found there
was up to 90% less neuroinammation and neuronal
death in the brain cells exposed to alcohol plus DHA
than in the cells exposed to alcohol alone.
An earlier meta-analysis by Collins and Neafsey,
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It appears that limited amounts of alcohol
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Alcohol in moderate amounts stresses cells
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Further studies are needed to conrm whether
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in chronic alcohol abusers, Collins says. At the very
least, its unlikely that it would hurt them.
But he adds that the best way for an alcohol abuser
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SOURCE: LOYOLA UNIVERSITY HEALTH SYSTEM
HEALTH MATTERS
Having Fun While Exercising Decreases Appetite
If youre looking to lose weight, think of your next workout
as a fun activity or as a well-deserved break, not exercise,
and youll eat less and lose more weight, according to a new
study from Cornell University Food and Brand Lab.
Published in Marketing Letters, the new study analyzed
the eating habits of people after walking 2 km (roughly 1.2
miles). One-half of the participants were told the walk was
exercise, while the others were told it was a scenic walk.
Researchers found that those who believed they com-
pleted an exercise walk ate 35% more chocolate pudding
for dessert than those who had been on a scenic walk.
On a different occasion, those thinking they had taken an
exercise walk ate 206 (124%) more calories than those
who had been told they were on a scenic walk.
According to researchers, the study shows one reason
why people in new exercise programs often nd themselves
gaining weight: New exercisers have a tendency to reward
themselves by overeating after their workout.
For beginning or veteran exercisers, the bottom line is to
do whatever you can to make your workout fun. Play music,
watch a video, or simply be grateful that youre working out
instead of working in the ofce, says Brian Wansink, PhD,
director of the Cornell Food and Brand Lab. Anything that
brings a smile is likely to get you to eat less.
SOURCE: CORNELL UNIVERSITY
Caffeine Intake May Worsen Menopausal Hot Flashes
A new Mayo Clinic study, published online ahead of
print in Menopause, found an association between caffeine
intake and more bothersome hot ashes and night sweats
in postmenopausal women. The study also showed an
association between caffeine intake and fewer problems
with mood, memory, and concentration in perimenopausal
women, possibly because caffeine is known to enhance
arousal, mood, and attention.
For the study, researchers conducted a survey using
the Menopause Health Questionnaire, a comprehensive
assessment of menopause-related health information
that includes personal habits and ratings of menopausal
symptom presence and severity. Questionnaires were
completed by 2,507 consecutive women who presented with
menopausal concerns at the Womens Health Clinic at Mayo
Clinic in Rochester, Minnesota, between July 25, 2005, and
July 25, 2011. Data from 1,806 women who met all inclusion
criteria were analyzed. Menopausal symptom ratings were
compared between caffeine users and nonusers.
Vasomotor symptoms (hot ashes and night sweats)
are the most commonly reported menopausal symptoms,
occurring in 79% of perimenopausal women and 65% of
postmenopausal women. Although it has long been believed
that caffeine intake exacerbates vasomotor symptoms,
research has challenged this assumption, as caffeine has
been both positively and negatively linked to hot ashes.
While these ndings are preliminary, our study suggests
that limiting caffeine intake may be useful for those post-
menopausal women who have bothersome hot ashes and
night sweats, says Stephanie Faubion, MD, director of the
Womens Health Clinic. Menopause symptoms can be chal-
lenging, but there are many management strategies to try.
Faubion recommends the following strategies:
Be aware of triggers such as spicy foods and hot beverages.
In addition to caffeine, limit alcohol and tobacco.
Dress in layers, so you can remove a layer when
youre warm.
Consider products to stay cool at night, such as wicking
sheets and sleepwear, fans, and cooling pillows.
Try stress management strategies such as meditation,
yoga, tai chi, acupuncture, and massage.
Maintain a healthy weight and exercise regularly.
Talk with your provider about hormone therapy and
nonhormonal prescription medications to alleviate
symptoms.
SOURCE: MAYO CLINIC
Vitamin D Deciency Raises Risk of Schizophrenia Diagnosis
Vitamin Ddecient individuals are twice as likely to be
diagnosed with schizophrenia as people who have sufcient
levels of the vitamin, according to a study published in the
Journal of Clinical Endocrinology & Metabolism.
Vitamin D helps the body absorb calcium and is needed for
bone and muscle health. The skin naturally produces this vitamin
after exposure to sunlight. People also obtain smaller amounts
of the vitamin through foods, such as milk fortied with vitamin
D. More than 1 billion people worldwide are estimated to have
decient levels of vitamin D due to limited sunshine exposure.
Schizophrenia is a mental illness with symptoms that can
include delusions and hallucinations. Since schizophrenia is
more prevalent in high latitudes and cold climates, researchers
have theorized vitamin D may be connected to the disorder.
This is the rst comprehensive meta-analysis to study the
relationship between the two conditions, says study author
Ahmad Esmaillzadeh, PhD, of the Isfahan University of Medical
Sciences in Iran. When we examined the ndings of several
observational studies on vitamin D and schizophrenia, we found
people with schizophrenia have lower vitamin D levels than
healthy people. Vitamin D deciency is quite common among
people with schizophrenia.
The researchers reviewed the ndings of 19 observational
studies that assessed the link between vitamin D and schizo-
phrenia. Combined, the studies looked at vitamin D levels and
the mental health of 2,804 adult participants. The studies used
blood tests to determine each participants vitamin D levels.
The meta-analysis found that people with schizophrenia
had signicantly lower levels of vitamin D in the blood
compared with the control groups. The average difference
in vitamin D levels between schizophrenic patients and
control participants was -5.91 ng/mL. People with vitamin D
deciency were 2.16 times more likely to have schizophrenia
than those with sufcient vitamin D in their bloodstreams. In
addition, 65% of the participants who had schizophrenia also
were vitamin D decient.
Theres a growing trend in the nutrition science eld to
consider vitamin D and its relationship to conditions such as
diabetes, cancer, heart disease, and depression, Esmaillzadeh
says. Our ndings support the theory that vitamin D may have
a signicant impact on psychiatric health. More research is
needed to determine how the growing problem of vitamin D
deciency may be affecting our overall health.
SOURCE: ENDOCRINE SOCIETY
SOLVING FOOD INSECURITY
By Beth W. Orenstein
Dietitians have the resources to end hunger
and obesity in their communities.
How can children be both hungry and overweight? Not only
is this possible, but its happening all too frequently in America,
Glenna McCollum, DMOL, MPH, RDN, now past president of
the Academy of Nutrition and Dietetics, told members of the
Pennsylvania Academy at their annual meeting in Bethlehem,
Pennsylvania, in April. In our country, far too many children
and families are struggling with food insecurity, she said in
delivering the Anna DePlanter Bowes Lecture.
The USDA denes food insecurity as lack of access to enough
food for an active, healthful life and indicates that, as of 2012,
49 million Americans suffer from it. Of those, 16 million are
children under the age of 18. At the same time, 23 million chil-
dren are overweight or obese.
Food insecurity is the highest among minority households, as
members of black and Hispanic households are twice as likely
as those in white households to be food insecure, McCollum
said. Location also plays a role, with food insecurity being high-
est in the South (16%) and West (15.8%). Though the rates are
slightly lower in the Northeast and Midwest (13.5%), the gure
still is high, she said.
And while food insecurity hasnt gotten
much worse in recent years, it hasnt gotten
much better, either, McCollum continued.
Poor Eating Habits
Children can be both hungry and over-
weight or obese because they lack access
to foods that are nutrient densefoods that
dietitians would recommend children eat.
Healthy foods can be more expensive than
calorie-dense foods, McCollum explained.
Research shows that food-insecure par-
ents report that the price of fruits and
vegetables are too high.
Also, food-insecure parents have
less access to quality food in their
neighborhoods. They may also lack
transportation to make more affordable
food purchases at larger grocery stores,
McCollum said. Their readily available
food choices in corner markets may leave
them and their children at risk of being
overweight or obese.
Additionally, when home pantries are full,
children may have regular and healthful
diets, McCollum said, but when pantries are empty, often at the
end of the month when food dollars are stretched, diets may be
lacking or meals may be skipped. This inconsistency in eating
patterns can cause changes in metabolism that promote fat
storage and weight gain, she said.
Children and parents in food-insecure homes also have
high levels of stress related to issues such as nances,
employment, health care, and housing. The stress, anxiety,
and depression can result in poor food choices and lead to
weight gain, McCollum said, noting that obesity needs to
be addressed in childhood. Studies have shown that few
school-age children can outgrow their weight problems.
The probability that an overweight school-age child
will become an obese adult is over 50%, she said. An
overweight adolescent has a 70% chance of becoming
overweight or obese as an adult, and obesity leads to more
morbidity and mortality.
Whats more, children who are food insecure have more
difculty in school. Kids who are hungry in kindergarten are
signicantly behind their peers in math and reading by the
third grade, and sometimes never catch up, McCollum said.
And adolescents from food-insecure homes are more likely
to have difculty getting along with others, she said. Theyre
seven times more likely to get in ghts with their peers and
four times more likely than their peers to require mental
health counseling.
CONFERENCE CURRENTS
What Are the Solutions?
The good news is that solutions to decrease food insecurity
and improve kids diet quality exist, McCollum said. Examples
include increasing participation in school meals and expanding
meal programs before, during, and after school and over the
summer. Other examples are increasing participation in the
Supplemental Nutrition Assistance Program for those who are
eligible, advocating for healthier foods and more nutrition edu-
cation in food banks, and enlisting the assistance of dietitians.
Food insecurity demands the attention of all segments of
society, McCollum said. Registered dietitian nutritionists are a
key to the solution, but it takes collaboration with hunger relief
professionals, health care and education sectors, and strong
public/private partnerships. All Academy members need to
become champions for kids and get involved in their schools
and communities to educate parents and leaders about food
insecurity and its consequences, she said.
There are plenty of opportunities for Academy members to
get involved even if their region or local area isnt among the
hardest hit, McCollum said. RDs need to educate parents and
communities about the consequences of kids going hungry and
how to combat the problem.
What You Can Do
McCollum suggested RDs do the following:
Get involved. Access suggested hunger action programs,
including the Hunger In Our Community: What We Can Do
Toolkit at www.kidseatright.org/volunteer. Also, share the
Nourish to Flourish infographic explaining the hungry and
overweight paradox, which is available at www.eatright.org/
Public/content.aspx?id=6442478348.
Learn more. A series of eight webinars on food insecurity
topics are available on the Academy Foundations website at
www.eatright.org/Foundation/content.aspx?id=6442478708.
RDs can nd quality resources targeting food-insecure popu-
lations at www.healthyfoodbankhub.org, a website developed
as part of the Future of Food collaboration with the Academy
Foundation, Feeding America, and the National Dairy Council.
Volunteer at a local food bank. Volunteers are needed to
sort, box, and repack donated food and direct it to where its
needed most. Volunteers also are needed to transport food to
charitable agencies and provide clerical help. You can nd food
banks in your area at FeedingAmerica.org. See if your local
food bank operates a Kids Caf program. The program provides
meals to kids and a safe place where they can get involved in
educational, recreational, and social activities. Kids Caf pro-
grams also offer nutrition education during the school year.
Advocate for school breakfasts. Studies show that kids
who eat school breakfast boost their scores on math, reading,
and other tests that require speed, memory, and cognition. For
more information about federal food/nutrition programs, visit
the Food Research and Action Center at www.frac.org.
Thank your grocer. Some grocery stores are starting to
position products differently and put healthier choices on the
more visible end caps. When you shop and see retailers making
such changes, show your appreciation, McCollum suggested.
Tell them who you are, and let them know you applaud them
and that it doesnt have to be all candy bars at the front counter.
Participate in Kids Eat Right. The Academy and its
foundation launched the Kids Eat Right initiative in 2010 to
support the efforts of First Lady Michelle Obama and the
White House to end the childhood obesity epidemic within a
generation. You can get involved in Kids Eat Right in several
ways. One is to educate families on strategies for providing
healthful meals each day. Offer them shopping ideas, cooking
strategies, and recipes through social media. Another is
to get involved in parent empowerment, encouraging and
helping them to be healthier role models for themselves and
their families. You can nd many toolkits with ready-made
presentations on a variety of healthful eating topics at
www.kidseatright.org/volunteer.
RDs dont have to start from scratch, McCollum said. You
can utilize the tools that are available to you through the
Academy and other resources.
Remember, collaboration is key to success and reducing
food insecurity nationwide, McCollum concluded. We know
we have to work together. We cant do it alone. She said she
has no doubt that RDs can meet the challenges and make a
big impact on the health of the nations children.
Beth W. Orenstein is a freelance health writer
living in Northampton, Pennsylvania.
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DYNAMICS OF DIABETES
HELP PATIENTS LOSE WEIGHT
By Jill Weisenberger, MS, RDN, CDE, FAND
Making adjustments to medications in accordance
with eating and exercise habits is key.
Jack, a middle-aged man with type 1 diabetes, started a
low-carbohydrate diet to lose weight. In the rst few days of
his new diet, he experienced the shaking, sweating, and mild
confusion that frequently accompanies hypoglycemia, which is
typically dened as blood glucose levels less than 70 mg/dL.
Jack didnt know that by consuming less carbohydrate than
usual, hed need to take less insulin.
Maura, a woman in her early 30s with type 2 diabetes,
takes glyburide to control her blood glucose levels. She
began an exercise program to lose weight in preparation
for her sisters wedding. Three weeks into the program, she
started experiencing hypoglycemia. To avoid this, she began
eating a carbohydrate-containing snack before and after each
workout. The calories from her snacks, however, exceeded
the calories burned during exercise, so her weight slowly
increased. She considered giving up exercise.
Mauras friend Lisa also has type 2 diabetes but controls her
blood glucose with metformin. Maura advised Lisa to eat a large
carbohydrate-containing snack before exercise, so she did.
Weight-Loss Concerns
Losing weight and keeping it off is
difcult for most people, but those with
diabetes of any type have additional
challenges. They need to consider how
changing their eating and activity habits may
affect their blood glucose levels, explains
Patti Urbanski, MEd, RD, LD, CDE, one of
the authors of the recent American Diabetes
Association nutrition position statement and a diabetes educator
on the Fond du Lac Reservation in Cloquet, Minnesota.
Insulin and medications that increase insulin levels in the
blood raise the risk of hypoglycemia (see table below). There-
fore, individuals taking these medications may need to mea-
sure their blood glucose more frequently, Urbanski says. In
addition, they may need medication adjustments when they
lose weight, increase physical activity, or change their diets,
and they will need to know the signs and symptoms of hypo-
glycemia and its appropriate treatment. Not all blood glucose
lowering medications promote hypoglycemia when used as
monotherapy. In fact, rarely do medications not listed in the
accompanying table cause hypoglycemia.
Ideally, patients, guided by a health care team member, should
be able to proactively reduce medications as necessary to avoid
hypoglycemia. Keeping food, activity, and blood glucose records
can provide the necessary information to make sound decisions
about treatment changes, says Linda Delahanty, MS, RDN, chief
dietitian and director of nutrition and behavioral research at
Massachusetts General Hospital Diabetes Center in Boston.
For instance, Jack worked with his health care team to reduce
his mealtime insulin to better match his carbohydrate intake.
Mauras health care provider also reduced her glucose-lowering
medications. Maura worked with a certied diabetes educator
and RD to learn about appropriate snack choices and ideal
timing of meals and snacks. Lisa was surprised to learn that
taking metformin put her at low risk of hypoglycemia, and that
she probably didnt need a snack immediately before exercise.
To ensure safety, dietitians should advise people at risk of
hypoglycemia to carry a carbohydrate source and, if possible,
their blood glucose meter while exercising. Dietitians also
should tell patients about typical hypoglycemia symptoms,
including shaking, nervousness, irritability, sweating, chills,
and dizziness.
1
Appropriate treatment for mild to moderate
hypoglycemia involves consuming a measured amount
of glucose (see The Rule of 15 sidebar on page 16). In
addition, patients should wear a medical ID bracelet or carry
identication stating they have diabetes.
Hypoglycemia can occur several hours or even a day
after exercising, so additional blood glucose monitoring
is indicated. Conversely, some people experience
hyperglycemia after intense bouts of activity, says New
Blood GlucoseLowering Medications Likely to Cause Hypoglycemia
Class of Medication Generic Name (Brand Name)
Sulfonylureas
Glimepiride (Amaryl), glipizide (Glucotrol),
glyburide (Diabeta, Micronase, Glynase)
Meglitinides Repaglinide (Prandin), nateglinide (Starlix)
Insulin All types
SOURCE: GARBER AJ, ABRAHAMSON MJ, BARZILAY JI, ET AL. AACE COMPREHENSIVE DIABETES MANAGEMENT ALGORITHM 2013.
ENDOCR PRACT. 2013;19(2):327-336.
York-based dietitian Susan Weiner, MS, RDN, CDE, CDN,
author of The Complete Diabetes Organizer.
People with diabetes also may have other health concerns,
such as comorbidities or complications that contraindicate
certain types of physical activity or require specic
modications. For example, patients with proliferative
retinopathy or moderate or severe nonproliferative retinopathy
may need to avoid lifting weights and placing their heads below
the level of their hearts to prevent intraocular bleeding, retinal
tears, or retinal detachment. Its prudent to have patients seek
clearance from their health care providers before they begin an
exercise program, Delahanty says.
In general, adults with diabetes are encouraged to perform
at least 150 minutes of moderate-intensity aerobic activity
each week, spread over at least three days with no more
than two consecutive days without exercise.
2
In the absence
of contraindications, adults with type 2 diabetes also should
perform resistance training at least twice weekly.
Weight-Loss Benets
Dietitians can assure overweight and obese patients that
losing even a few pounds can result in meaningful improvements
in blood glucose and other health parameters. In fact, losing
as little as 2% of body weight can benet glycemic control,
Delahanty says. Losses of 5% to 10% of body weight are
associated with signicant improvements in blood glucose, blood
pressure, and lipids with fewer medications needed to treat these
cardiovascular risk factors. Other benets include improvements
in sleep apnea, knee pain, physical functioning and mobility,
urinary incontinence, depression, and quality of life, she adds.
Diabetes Remission
In some patients, weight loss and increased physical
activity can induce either partial or complete remission of
type 2 diabetes, Delahanty says. In the Look AHEAD study that
examined more than 5,000 overweight or obese people with
type 2 diabetes, 11.5% of participants in the intensive lifestyle
intervention arm achieved complete remission, dened as
normal blood glucose levels with no medications, or partial
remission, dened as blood glucose levels in the prediabetes
range with no medications.
3
Remission rates were higher
in those who achieved the greatest weight loss and tness
improvements, had diabetes for a shorter time, had lower initial
body weight, had better initial glycemic control, and didnt take
insulin, Delahanty says.
Though weight loss has potential benets at any time, It
appears that weight loss has the biggest impact on glycemic
control when the person is still in the early stages of type 2
THE BENEFITS
OF BARLEY
When talking to your clients about a healthy
diet, Go Barley! This ancient grain is versatile,
tasty and has been shown to:
Lower cholesterol
Moderate glucose response
Stimulate satiety
For more information, visit www.GoBarley.com
diabetes, Urbanski says. In a retrospective study of 2,574
patients, losing weight shortly after their type 2 diabetes
diagnosis predicted improved blood pressure and glycemic
control despite weight regain.
4

An important take-home message is that losing weight has
many other health benets even if it doesnt make the diabetes
go away, Urbanski says. And if people adopt healthier eating
habits and increase their activity while theyre trying to lose
weight, they very likely will see improved blood glucose even if
they dont lose weight.
Patients need to know that type 1 diabetes wont go away with
weight loss. Type 1 diabetes is an autoimmune disease, Weiner
says, and currently theres no cure. However, if patients with
type 1 diabetes are overweight or obese, weight loss may reduce
the amount of insulin they need for blood glucose control.
Is There an Ideal Weight-Loss Diet?
Patients with diabetes may ask whether theres a special
diet they can try to help them lose weight. However, a review
of the evidence suggests theres no single ideal weight-loss
diet for people with diabetes. In interventional studies lasting
at least one year and targeting weight loss in individuals with
type 2 diabetes, weight loss ranged from an average of 1.9 to
8.4 kg (4.2 to 18.5 lbs) at the one-year mark.
5

The two studies reporting the greatest weight loss at
one year used different approaches. The Look AHEAD trial
reported an average weight loss of 8.6% of initial body weight
and used a calorie-controlled plan, meal replacements, and
physical activity.
3
A study using a Mediterranean-style eating
pattern with no more than 50% of calories from complex
carbohydrates reported losses averaging 6.2 kg (13.7 lbs).
6

The ideal eating pattern for achieving weight loss is one
thats reduced in calories and considers each individuals
typical eating patterns, food preferences, and metabolic
goals, and at the same time is a sustainable way of eating
rather than a short-term diet that relies on willpower,
Delahanty says.
By paying special attention to the risk of hypoglycemia
and other concerns unique to people with diabetes,
dietitians can individualize care to help them lose weight
and live healthier lives.
Jill Weisenberger, MS, RDN, CDE, FAND, is a freelance
writer and a nutrition and diabetes consultant to the food industry,
including Daisy Brand Cottage Cheese and Good Fats 101. She has
a private practice in Newport News, Virginia, and is the author of
Diabetes Weight Loss Week by Week and the forthcoming
The Overworked Persons Guide to Better Nutrition.
References
1. Hypoglycemia (low blood glucose). American Diabetes
Association website. http://www.diabetes.org/living-with-
diabetes/treatment-and-care/blood-glucose-control/
hypoglycemia-low-blood.html. Updated May 20, 2014.
Accessed May 23, 2014.
2. American Diabetes Association. Standards of medical
care in diabetes. Diabetes Care. 2014;37(1):S14-S80.
3. Delahanty LM. The Look AHEAD study: implications for
clinical practice go beyond the headlines. J Acad Nutr Diet.
2014;114(4):537-542.
4. Feldstein AC, Nichols GA, Smith DH, et al. Weight
change in diabetes and glycemic and blood pressure control.
Diabetes Care. 2008;31(10):1960-1965.
5. Evert AB, Boucher JL, Cypress M, et al. Nutrition
therapy recommendations for the management of adults
with diabetes. Diabetes Care. 2013;36(11):3821-3842.
6. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a
Mediterranean-style diet on the need for antihyperglycemic
drug therapy in patients with newly diagnosed type
2 diabetes: a randomized trial. Ann Intern Med.
2009;151(5):306-314.
THE RULE OF 15
1
Both losing weight and becoming more active
improve insulin action, which increases the risk of
hypoglycemia in some people with diabetes. Dietitians
can share the following treatment guidelines with
patients who experience blood glucose levels below
70 mg/dL:
Consume 15 g of carbohydrate. Its best to use
pure glucose in the form of tablets, gel, or liquid
because it works more quickly and contains a min-
imum of calories. The following are some good
choices that also include food:
two to fve glucose tablets (check the label for
the proper dosage);
one tube of glucose gel;
2 T raisins;
4 oz regular soda or fruit juice;
1 T sugar or honey; or
1 cup nonfat or low-fat milk.
Wait 15 minutes after treating before eating anything
else or resuming activity. Consume an additional 15 g
of carbohydrate if blood glucose remains low. Continue
this procedure until blood glucose normalizes.
VEGETARIAN NUTRITION
INDIAN CUISINE
Foods That Hold a Special Place
in Plant-Based Food Traditions
By Sharon Palmer, RDN
Most vegetarians agree: Indian food is one of the tastiest
plant-based cuisines. With fragrant curry, dal, and korma
dishes lending their aromatic, avorful qualities to the plate,
who needs meat? Indeed, Indian food culture has a long history
of dishing up delicious vegetarian food. Data show that 42%
of households in India are vegetarian (dont eat sh, meat, or
eggs), and 58% are less strict vegetarians or nonvegetarians.
1
Gita Patel, MS, RDN, CDE, LD, CLT, author of Blending
Science With Spices, explains that Indian culture leans toward
vegetarianism due to Hinduism, which hosts a central theme
of nonviolence, including animals. A profound respect for all
life is a common Hindu belief that supports vegetarian eating
styles, adds Vandana Sheth, RDN, CDE, a spokesperson for
the Academy of Nutrition and Dietetics.
However, British colonial inuences and Western food
trends, such as the emergence of fast-food restaurants,
have brought more animal foods into India, Patel says. With
the globalization of the world and technology, some of the
urban lifestyle changes have signicantly affected traditional
food practices in India, Sheth adds, listing as evidence the
increasing number of fast-food restaurants and premade
foods replacing traditional meals in India.
Traditional Eating Patterns
A lot of people are drawn to Indian cuisine. People like
the avors, herbs, and spices, Patel says, noting that home
cooking is vastly different from what youre likely to sample in
an Indian restaurant.
The traditional eating pattern is very balanced, Patel says.
She describes typical meals consisting of dal (a legume dish),
rice, roti (bread), vegetable, salad, fruit, and a yogurt or butter-
milk drink, which may vary slightly depending on the region.
Indeed, theres scientic consensus that a disease-protective
diet is based on a variety of whole plant foods, which sums up
the traditional Indian eating pattern. The traditional Indian
vegetarian diet is one thats rich in a wide variety of grains,
beans, lentils, vegetables, fruits, nuts, seeds, spices, and herbs.
Research has found that vegetarians have a lower risk of heart
disease and some types of cancer, Sheth says. The National
Cancer Institute reports that cancer rates are lower in India than
in Western countries, and that diet characteristics such as a high
intake of fruits, vegetables, spices, and tea may be responsible
for protecting Indians against certain forms of cancer.
2
Chana Dal Stew
Makes 6 servings (about 1 cup each)
Ingredients
8 oz (227 g or 1
1
4 cups) dried chana dal
5 cups (711 ml) water
2 medium carrots, sliced
1 medium red bell pepper, chopped
1 medium onion, chopped
2 small red potatoes, unpeeled, chopped
2 small tomatoes, chopped
1 tsp garam masala
1
2 tsp turmeric
1
2 tsp grated fresh ginger
2 medium garlic cloves, minced
1
4 tsp crushed red pepper
1 T unsalted creamy peanut butter
Directions
1. Place all ingredients in a large pot, stir well, cover,
and bring to a simmer.
2. Cook for about 50 minutes until the vegetables
and chana dal are tender.
Nutrient Analysis per serving
Calories: 215; Total fat: 1 g; Sat fat: 0 g; Sodium:
34 mg; Total carbohydrate: 40 g; Fiber: 14 g; Sugars: 4 g;
Protein: 12 g
RECIPE COURTESY OF SHARON PALMER, RD, FROM PLANT-POWERED FOR LIFE (THE
EXPERIMENT, 2014)
Chana Dal Stew

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Key Components
While the specic dishes may vary according to dif-
ferent regions of India, the key ingredients basically
are the same and include the following:
Vegetables: Vegetables are grown all over the
country due to the climate, Patel says, adding that
many vegetables are unique to India, such as specic
types of gourds, radishes, beans, and greens. However,
other dishes are based on more familiar vegetables,
such as beets, Brussels sprouts, cabbage, carrots,
cauliower, celery, cucumber, corn, eggplant, green
beans, various greens, okra, onions, peas, peppers,
potatoes, radishes, spinach, squash, and tomatoes. In
addition, fermented foods such as pickled vegetables
are a regular feature in Indian cuisine.
Grains: Rice and wheat are staples in India and
used in atbreads (eg, dosa, roti, chapati), doughs
(eg, samosa, kachori), and side dishes (rice) to
accompany meals.
Legumes: Indian cuisine relies on the regular and
avorful use of legumes, such as black-eyed peas,
chickpeas, lentils, and beans. In addition to dal, many
legumes are sprouted or used as our in breads.
Fruits: Apples, apricots, bananas, gs, grapes,
guavas, lychees, loquats, mangoes, oranges, papa-
yas, passion fruit, and sweet limes are common fruits
in India.
Dairy: From milk and buttermilk to yogurt and
paneer (fresh cheese), dairy products are regular
features of the Indian diet. Patel reports that most
Indian households receive fresh milk, which is then
used for beverages and cooking. Households make
their own ghee (claried butter) from the milk fat, and
leftover milk is made into fresh yogurt every day.
Vegetable oils: Most oils used in traditional cook-
ing are unrened vegetable oils, such as peanut or
sesame. However, Patel reports an increase in the use
of rened oils, such as soybean oil, in modern cooking.
Sprouted Moong Bean Salad
Makes 6 servings
Ingredients
Dressing
1 T oil (olive or canola)
1
2 to 1 tsp salt (optional)
1 tsp freshly roasted and ground cumin
1 T lemon juice
Beans
2 cups sprouted moong (also known as mung) beans
Salt, to taste
1 cup chopped tomatoes
1 cup chopped cucumber
1
2 to 1 cup shredded cabbage
1 seeded and diced green chili (optional)
1 tsp minced ginger (optional)
1
4 cup chopped cilantro
Directions
1. Mix all of the dressing ingredients and set aside.
2. Heat
1
4 cup of water in a pan with sprouts and salt.
When it comes to a boil, turn the stove off, and leave it
covered for 4 to 5 minutes.
3. Mix the sprouted beans with all of the ingredients,
stir in the dressing, and top with cilantro.
Calories: 111; Total fat: 3 g; Sat fat: 0 g; Sodium: 8 mg;
Total carbohydrate: 17 g; Fiber: 6 g; Sugars: 2 g; Protein: 6 g
RECIPE COURTESY OF VANDANA SHETH, RDN, CDE
Indian cuisine relies on the regular
and avorful use of legumes, such
as black-eyed peas, chickpeas,
lentils, and beans. In addition to
dal, many legumes are sprouted
or used as our in breads.
Herbs and spices: At the heart of Indian food is a long
list of culinary herbs and spices that have been used for
centuries, many of which are proven to have antioxidant,
anti-inammatory, antimicrobial, and anticancer effects.
Indian spices include amchur (made from mangoes), aniseed,
asafetida (a pungent, onionlike avor), bay leaf, black pepper,
cardamom, chilies, cinnamon, cloves, coconut, coriander,
cumin, dill, fennel, fenugreek, garam masala (a spice blend),
garlic, ginger, mango powder, mint, mustard, nutmeg, onion
seeds, parsley, pomegranate seeds, poppy seeds, saffron,
sesame seeds, tamarind, and turmeric.
Tips to Get Cooking
The following are some tips when cooking Indian
vegetarian food:
For true favor, use Indian spices. Dont just rely on curry
powder for every dish; stock your kitchen with the basics, such
as cumin seeds, cayenne pepper, ground coriander, turmeric,
brown mustard seeds, and the spice blend garam masala.
Dont be afraid to try an Indian recipe. Many recipes use
standard cooking utensils you may have at home and take
only minutes to prepare.
Dont feel you have to prepare a full Indian meal with a
wide variety of dishes you may see at a typical restaurant.
Keep it simple with one legume dish that can be served with
rice and a salad.
Sharon Palmer, RDN, is a contributing editor to
Todays Dietitian and the author of
The Plant-Powered Diet and Plant-Powered for Life.
References
1. Growth and concentration in India. Food and Agriculture
Organization of the United Nations website. http://www.fao.org/
wairdocs/lead/x6170e/x6170e09.htm#fn6. Accessed May 25, 2014.
2. Sinha R, Anderson DE, McDonald SS, Greenwald P. Cancer
risk and diet in India. J Postgrad Med. 2003;49(3):222-228.
Stir-Fried Vegetables With Edamame
Makes 6 servings
Ingredients
1 tsp cumin seeds
2 T olive oil
1 T sesame seeds
3 cloves garlic, chopped
1
2 jalapeo pepper, sliced in half (or use cayenne
or black pepper to taste)
1
1
2 cups fresh or frozen corn
1
4 tsp turmeric
1
4 tsp salt (or to taste)
1 cup frozen edamame, thawed
3 cups zucchini, sliced
1 cup sweet red bell pepper, sliced
1 cup chopped (with tender stems) cilantro
Juice of
1
2 lemon
1
2 tsp lemon zest
Cooked rice, millet, or quinoa
Directions
1. Heat a 2- to 3-qt skillet or pan on medium-high heat and
add cumin seeds.
2. When the seeds begin to change color and give an aroma,
add olive oil, sesame seeds, and chopped garlic and turn
heat to medium.
3. Fry the garlic for a minute and add jalapeo, corn, tur-
meric, and salt. Stir then cook covered for 2 to 3 minutes.
4. Add edamame, zucchini, and red pepper. Stir then cook
covered for 3 to 4 minutes.
5. Before serving, add chopped cilantro, fresh lemon juice,
and lemon zest. Stir to mix all the ingredients.
6. Serve the vegetables over rice, quinoa, or millet.
Enjoy leftovers for lunch in a pita pocket.
Calories: 121; Total fat: 7 g; Sat fat: 1 g; Sodium: 10 mg;
Total carbohydrate: 14 g; Fiber: 4 g; Sugars: 5 g; Protein: 4 g
RECIPE AND PHOTO COURTESY OF GITA PATEL, MS, RDN, CDE, LD, CLT
VITAMIN B
12

By Amelia R. Sherry
Research suggests deciencies in this vitamin
are more common than we may think.
Dietitians are well aware that vitamin B
12
is one of the key
nutrients in which vegetarians and vegans are decient, and
that they need guidance on how to increase their intake. But
can more be done to protect these clients against this nutrient
shortfall and its severe consequences?
According to one researcher, the answer is yes. Registered
dietitian nutritionists should recommend that all vegetarians,
including even semivegetarians, be tested for B
12
, says Roman
Pawlak, PhD, RD, an associate professor in the department
of nutrition science at East Carolina University in Greenville,
North Carolina.
Its long been accepted that a vegan diet poses a high risk
of vitamin B
12
deciency, but the notion that less restrictive
vegetarians should be closely monitored for shortfalls remains
controversial. Pawlak bases his recommendation for testing
in part on a 2013 literature review he coauthored, in which 18
articles were examined that assessed the vitamin B
12
status of
vegetarians, including lacto-ovo-vegetarians, lacto-vegetarians,
vegans, and those following a macrobiotic diet. The results
showed that 62% of pregnant women, 25% to almost 86% of
young children, 21% to 41% of adolescents, and 11% to 90% of
elderly subjects were decient in vitamin B
12
.
1

Accurate Measures
Previous studies that have identied B
12
deciency among
vegetarians have shown signicantly lower prevalence rates
than Pawlaks 2013 literature review.
2-4
Pawlak argues that
his 2013 study paints a more realistic picture of the prevalence
of B
12
deciency because he and his colleagues limited their
research to studies assessing B
12
status using only serum or
urinary methylmalonic acid (MMA), holo-transcobalamin-II
(holo-TCII), or both, which are considered more specic and
accurate measures of vitamin B
12
depletion and deciency com-
pared with the more commonly used serum B
12
test.
5,6
Notably,
MMA and holo-TCII are the two tests, along with homocysteine,
that the Academy of Nutrition and Dietetics (the Academy) cur-
rently recommends for determining B
12
status in vegetarians.
7

In fact, the widely used serum B
12
test has been characterized
as an unreliable measure of deciency because the cutoff point
for determining a deciency is most often dened as 200 pg/
mL or lower, which often is considered too low.
8
In other words,
researchers who use 200 pg/mL as the cutoff point are exclud-
ing a signicant number of decient patients with levels falling
between 200 pg/mL and 350 pg/mL. Symptoms of B
12
deciency
have been noted up to a concentration of 350 pg/mL, explains
Katherine L. Tucker, PhD, a professor of nutritional epidemiol-
ogy in the department of clinical laboratory and nutritional
sciences at the University of Massachusetts Lowell.
Indeed, low serum B
12
is considered a late indicator of de-
ciency in that by the time blood levels fall, clinical symptoms
such as irreversible peripheral neuropathy already may be
present. And serum B
12
measures the total amount of B
12
cir-
culating in the blood, up to 80% of which may be inactive
analogues, which can block B
12
absorption.
9
Holo-TCII, by com-
parison, is considered more sensitive because it measures just
the active form of B
12
. MMA also is considered more sensitive
because cobalamin is required to convert methylmalonyl coen-
zyme A to succinyl coenzyme A; therefore, rising MMA levels
are an early indicator that active B
12
has fallen.
10

Jumping the Gun on Testing?
Despite the current research, not all dietitians are convinced
that Pawlaks 2013 review proves that all vegetarians should be
tested for vitamin B
12
deciency. The research studies that are
available to be included in this review are limited, particularly
with regard to Western countries in which B
12
-fortied foods
are commonly consumed, though its not the fault of the review
that the studies are limited; there just arent many out there,
says Reed Mangels, PhD, RD, LDN, an adjunct professor of
nutrition at the University of Massachusetts Amherst and the
nutrition advisor for the Vegetarian Resource Group.
The only study on pregnant women was conducted in
Ethiopia where a diet primarily composed of maize was eaten,
for example. Also, while the studies spanned 22 years, very
few recent studies, such as those conducted in the past 10
years, were available and included. In recent years, more
vegetarians seem to be aware of the need to include reliable
sources of B
12
in their diets, Mangels says, adding that she
considers the evidence for across-the-board testing, which
can be very costly, to be shaky at best.
Another weakness of the literature review: While MMA and
holo-TCII are considered more accurate measures than serum
B
12
, neither test, nor homocysteine, on its own is considered
SUPPLEMENT SPOTLIGHT
a gold standard diagnostic tool for identifying deciency.
10
For
example, serum MMA may be elevated because of intestinal
bacterial overgrowth, while urinary MMA may be high due to
impaired kidney function. Holo-TCII levels may dip temporarily
due to drug interactions or be affected by pregnancy, oral con-
traceptives, folate disorders, and alcoholism, plus folate, renal
dysfunction, and vitamin B
6
deciency can impact homocys-
teine levels.
10,11
For these reasons, it has been recommended
that abnormal results of two or more tests be used to conrm
a deciency.
10
In Pawlaks 2013 literature review, only three of
the 18 studies required two tests to establish a vitamin B
12
de-
ciency. However, those studies that used two tests still revealed
that deciencies existed in 55% to 69% of vegetarians.
Whats more, because no universally established criteria
exists for dening a vitamin B
12
deciency, the cutoff points for
determining shortfalls differed among the studies examined.
However, Pawlak believes that if uniform measures were
used, prevalence would be even higher. I am convinced that if
authors of the published studies used appropriate B
12
deciency
criteria, virtually all of their participants would have been
diagnosed with a deciency, he says.
Stages of Deciency
While across-the-board testing is expensive and remains con-
troversial, understanding the usefulness of sensitive diagnostic
tests is helpful for dietitians who suspect a client or patient may
have a vitamin B
12
deciency. Mangels agrees that detecting B
12

depletion before it becomes a deciency is important. You dont
want to wait until symptoms appear because by that time, there
could be irreversible damage, she says.
The early stages of B
12
deciency, also referred to as B
12

depletion, often involves a fairly latent condition characterized
by vague or no symptoms (eg, fatigue, forgetfulness), which can
go unnoticed for months or years.
8,12
Then suddenly, depletion
can progress to later stages without warning and in as little
as two months, lead to permanent peripheral neuropathy and
cognitive damage.
13

Sensitive tests can help a clinician detect B
12
depletion (or a
subclinical deciency ) before it progresses. Specically, the
holo-TCII test can identify B
12
depletion (also known as stages
I and II of B
12
deciency), which is dened as having a negative
balance of B
12
, or simply when the amount absorbed falls below
the amount lost daily since it measures only the active amount
of B
12
circulating in the blood.
4
Elevated MMA and homocysteine
levels indicate a functional deciency of B
12
, which is stage III.
Total serum B
12
, which includes inactive and active forms,
usually doesnt fall until stage IV when more obvious clinical
manifestations are apparent.
Counseling and Protection
When working with vegetarian and vegan clients, the rst
step for dietitians is to assess their B
12
intake from foods
and supplements to determine whether theyre meeting the
Recommended Dietary Allowance (RDA), which is 2.4 mcg/day
for adults and elders and 2.6 and 2.8 mcg/day for pregnant and
lactating women, respectively. This should include serving
sizes, frequency, and sources, Mangels says. For example,
taking a large supplemental dose once weekly may be ne, but
eating eggs once or twice a week is not.
Dietitians can recommend testing once a dietary assess-
ment reveals a low intake. I would especially recommend it for
any client who is reluctant to supplement or eat fortied foods.
If they feel they dont need it, a test such as MMA, holo-TCII, or
homocysteine can help prove to them otherwise, Mangels says.
If these three, more sensitive tests arent available, practi-
tioners can use serum B
12
, but they should be aware that many
lab values consider serum concentration even slightly below
200 as normal. So, in such a case, the dietitian needs to under-
stand how to interpret the results rather than just accept the
description from the lab, Pawlak says.
For clients who resist testing altogether, RDs should stress
the profound risks associated with vitamin B
12
depletion and
elevated MMA and homocysteine, such as anemia, Alzheimers
and cardiovascular diseases, dementia, depression, and nerve
degeneration, which may help change their minds.
When providing nutrition counseling to vegan and vegetarian
clients, dietitians should recommend they eat foods fortied
with vitamin B
12
or suggest they take a supplemental amount
that meets the RDA, says Toby Smithson, MSNW, RDN, LDN,
CDE, a spokesperson for the Academy. However, controversy
exists over whether the RDA is enough, since research has
shown that anywhere between 4 and 10 mcg may be needed to
raise B
12
to appropriate levels in healthy subjects.
14,15
For those
who already have a deciency or serum blood level below 350
pg/mL, some experts recommend amounts 40 to 100 times
higher than the RDA.
Vegetarian elders also should eat fortied foods or take
a supplement since the naturally occurring B
12
found in food
sources often is bound to protein. Atrophic gastritis, a condition
affecting up to 30% of older adults, reduces the secretion of
hydrochloric acid and thereby limits protein-bound vitamin B
12

absorption. Having a list handy of reliable sources of fortied
foods, including plant milks, meat substitutes, breakfast cere-
als, some energy bars, and supplements, also can be helpful
for all clients, Mangels says.
Moreover, dietitians should be vigilant about discussing the
importance of vitamin B
12
supplementation when counseling
pregnant and lactating women and children since the risks of
deciency, such as neurological damage and developmental
delay, in these groups can be especially devastating.
Amelia R. Sherry is a freelance writer, a dietetic intern at
CUNY Hunter College School of Public Health in New York City,
and the founder of the blog FeedingIsla.com.
For references, view this article on
our website at www.TodaysDietitian.com.
Diabetes Meal
The Top 10
BY CONSTANCE BROWN-RIGGS, MSEd, RD, CDE, CDN
Its been two decades since the American Diabetes
Association (ADA) announced there was no longer a universal diet
for people with diabetes. This message was reemphasized in 2013
when the ADA issued a new position statement, Nutrition Therapy
Recommendations for the Management of Adults With Diabetes.
Moreover, the ADA moved away from using the word diet, opting to
focus on meal patterns or dietary patterns instead.
The word diet gives people the notion that theres an on and off,
says Hope Warshaw, MMSc, RD, CDE, BC-ADM, owner of Hope Warshaw
Associates in Alexandria, Virginia. Reality is that this cant be the case if
one is going to be successful at achieving diabetes control and/or weight
management long term.
Because the media often promotes various fad diets for weight loss and
other health conditions, encouraging clients and patients and other health
care providers to move away from the notion of following a particular diet
can be difcult.
Recently, US News & World Report ranked what it called 10 diets as
the most effective for managing diabetes. This article will discuss each
of them and the research regarding their effectiveness, strengths, and
weaknesses.
Best Eating Plans for Diabetes
Every year since 2010, US News & World Report has ranked the years
most popular diets. Using a panel of experts, including RDs and physicians
specializing in diabetes, heart health, and weight loss, diets are ranked
in eight categories, such as diabetes and heart disease prevention and
control, as well as easiness to follow and likelihood of weight loss.
According to the 2013 ADA nutrition recommendations, there are
several meal patterns that have shown good results in people with
diabetes. Many of these meal patterns, such as the Mediterranean,
vegetarian, vegan, and DASH dietary plans, can be found among the
US News & World Report list of best diets for people with diabetes.
The Biggest Loser and DASH approaches tied for rst place, while the
Engine 2, exitarian, Mayo Clinic, Ornish, and vegan approaches tied
for second place. Tying for third place were the anti-Inammatory,
Mediterranean, and vegetarian diets.
Biggest Loser
The Biggest Loser uses the 4-3-2-1 Biggest
Loser Pyramid for the nutritional choices, says
Amy Jamieson-Petonic, MEd, RD, CSSD, LD,
LMT, a Cleveland-based spokesperson for the
Academy of Nutrition and Dietetics (the Acad-
emy). The diet suggests consuming four serv-
ings of fruits and vegetables per day, three
servings of protein foods, two servings of whole
grains, and no more than 200 kcal from the
extras category at the top of the pyramid.
Can it prevent or control diabetes? The
diet can help control blood sugar. Eating less
rened carbohydrates and more dietary ber,
fruits, and vegetables, along with physical
activity, can improve insulin resistance
and improve glucose levels in people with
diabetes, Jamieson-Petonic says.
The Diabetes Prevention Program provides
evidence that people at risk of type 2 diabetes
can delay or avoid developing the disease by
losing weight through regular physical activity
and a diet low in fat and calories. Data from The
Biggest Loser show some contestants no longer
had indications of the metabolic syndrome,
reducing the risk of type 2 diabetes.
1
In a retrospective analysis of 35 Biggest Loser
contestants, those with prediabetes experienced
decreased hemoglobin A1c levels, from 5.6% to
5.1% at week 29. The drop also was signicant for
those with type 2 diabetes, who saw A1c reduced
from 6.9% to 5.2%. Participants who had been
taking metformin discontinued it during week 1.
Reductions also were observed in fasting glucose,
fasting insulin, and insulin resistance index.
2
Strengths and weakness: Its a solid nutri-
tion program that offers a well-balanced, high-
ber diet full of whole grains, lean proteins,
fruits, and vegetables as well as adequate
water, Jamieson-Petonic says.
Supplements arent recommended as part of
the diet, but Jamieson-Petonic says a supple-
ment is warranted because the lowest calorie
range suggested in the plan is 1,050. A multivi-
tamin should be recommended for people con-
suming less than 1,200 kcal per day, she says.
DASH
In 1995, the National Heart, Lung, and Blood
Institute funded the landmark diet and blood
pressure study called the Dietary Approaches
Patterns Diabetes Meal
Nutrition professionals review US News
& World Reports highest-ranked diets
for clients and patients.
FIRST PLACE WINNERS
1
to Stop Hypertension (DASH) trial. The study was remarkable,
illustrating for the rst time that dietary intervention alone signicantly
lowers systolic and diastolic blood pressure in hypertensives and
nonhypertensives, says Janet Bond Brill, PhD, RDN, LDN, FAND,
author of Prevent a Second Heart Attack: 8 Foods, 8 Weeks to Reverse
Heart Disease and two other books.
Can it prevent or control diabetes? The DASH diet is excellent for pre-
venting and controlling diabetes, Brill says. Most research on the DASH
diet has been in people without diabetes, but there was a small study pub-
lished January 2011 in Diabetes Care that examined people with type 2 dia-
betes. The participants, who were randomly assigned to a control diet or
the DASH eating plan with a sodium restriction of 2,300 mg/day, experi-
enced reduced body weight and improved fasting blood glucose, A1c, blood
pressure, and other cardiovascular risk factors.
Being overweight is one of the biggest risk factors for developing type 2
diabetes, and combining the DASH eating pattern with calorie restriction
has been found to help people shed pounds and reduce other risk factors,
such as the metabolic syndrome.
Strengths and weaknesses: The DASH eating plan has been shown to
help control high blood pressure, which is prevalent in people with diabe-
tes. From 2005 to 2008, 67% of adults aged 20 and older with self-reported
diabetes had blood pressure greater than or equal to 140/90 mm Hg or
used prescription medications to control their hypertension.
3

The DASH diet is an exchange-based meal plan with various calorie
levels, which Brill considers a strength. It has a specic daily level of
minerals and calories to strive for, plus it restricts sodium intake, she
says. The biggest weakness: There isnt as much clinical research
backing effectiveness for diabetes management, she says.
Engine 2
Fireghter Rip Esselstyn created the Engine 2 diet, and his fathers
landmark research on the prevention and reversal of heart disease
through a plant-based diet is what inspired him to develop the eating
plan.
4
The author puts readers on a plant-based diet consisting of whole
grains, vegetables, fruits, soy products, tofu, and legumes and steers
clear of animal-based products and rened foods, explains Jim White,
RDN, ACSM HFS, owner of Jim White Fitness & Nutrition Studios in
Virginia Beach, Virginia, and a spokesperson for the Academy.
Can it prevent or control diabetes? According to Esselstyn, the Engine 2
diet will help people with diabetes get off their medications, White says.
The diet provides two options: the reghter,
which requires a complete and immediate life-
style change, avoiding all animal products, pro-
cessed foods, and vegetable oils; and the re
cadet, which allows for a more gradual change
to ultimately eat a vegan diet. Weight loss is
inevitable with either approach, White says, and
thats good news.
If one is overweight with prediabetes and
early-onset type 2 diabetes, then a small
amount of weight loss7%can help the
person improve their glycemia, lipids, and blood
pressure, Warshaw says. After reviewing six
low-fat vegan studies in individuals with type 2
diabetes, the writers of the 2013 ADA position
statement found that the research consistently
showed improvement in glycemic control and
cardiovascular risk factors but only when sub-
jects lost weight.
Strengths and weaknesses: The Engine 2
diet is low in fat, which leads to weight loss,
and thats a strength, White says. However, the
diet requires a complete lifestyle change with
considerable meal planning and preparation,
4

which will take a strong commitment to carry
out, he says. Instead, Id recommend this diet
for current vegetarians looking for a resource
for new recipes or vegetarians looking to prog-
ress to a vegan diet.
Flexitarian
The exitarian diet is a vegetarian diet
with exibility to include occasional meat and
poultry, explains Dawn Jackson Blatner, RD,
a certied specialist in sports dietetics and
the author of The Flexitarian Diet. Unlike many
vegetarian eating plans that eliminate meat,
The exitarian diet philosophy is proplants,
not antimeat, Blatner says. She believes, and
evidence supports, that people who eat more
plants tend to consume fewer calories and
more nutrients, such as ber, and a wide variety
of disease-ghting phytonutrients that are
available only in plants.
Can it prevent or control diabetes? The 2013
ADA nutrition recommendations for preventing
and controlling diabetes include weight loss and
eating high-ber foods such as fruits, vegeta-
bles, whole grains, and legumes.
Individuals following an energy-restricted,
plant-based diet such as the Mediterranean or
vegetarian eating patterns have been shown to
experience improved glycemic control.
5
Flexi-
tarian eating can lead to weight loss, and weight
The Mayo Clinic diet mirrors the 2013 ADA
nutrition recommendations. There are heart-
healthy food choices and recommendations
for portion control, exercise, and limiting
excess fat, sugar, alcohol, and calories.
Melissa Joy Dobbins, MS, RDN, CDE
SECOND PLACE WINNERS
2
The Diabetes Prevention Program provides evidence on the benets of
weight loss, and the 2013 ADA nutrition recommendations state that there
isnt an ideal eating pattern for everyone, and that total energy intake is
important. Anyone with prediabetes, diabetes, or a family history of dia-
betes can benet from this diet plan, Dobbins says. However, people with
diabetes should talk with their health care provider about whether carb
counting also should be a part of their individualized plan.
Strengths and weaknesses: The Mayo Clinic diet mirrors the 2013 ADA
nutrition recommendations. There are heart-healthy food choices and rec-
ommendations for portion control, exercise, and limiting excess fat, sugar,
alcohol, and calories, Dobbins says.
The 2013 ADA nutrition recommendations show that the quantity
and type of carbohydrate in food impacts blood glucose levels, and the
total amount of carbohydrate eaten is the primary predictor of glycemic
response. One weakness of the Mayo Clinic diet is the absence of carb
counting. Even healthy carbs in healthy amounts may raise blood sugar
in people with diabetes, Dobbins says.
US News & World Report experts thought the Mayo Clinic diet was mod-
erately easy to follow. However, Dobbins suggests that individuals with dia-
betes may nd the diet and activity recommendations daunting to follow on
their own. I strongly recommend talking with a certied diabetes educator
to help create a personal, step-by-step action plan that takes into account
the individuals lifestyle and supports behavior change, she says.
Ornish
Dean Ornish, MD, ranked foods from most to least healthful. No
foods are forbidden, and theres no all-or-nothing approach. Results
depend on the degree to which an individual limits the least healthful
foods. For example, his recommendations to reverse heart disease
loss can help prevent and manage diseases
such as diabetes, Blatner says.
Strengths and weaknesses: Because the
diet is balanced and exible, it can be used by
anyone, but portions matter as much as food
choice, Blatner says. Its important for anyone
following a plant-based diet to understand the
right portions for their body, lifestyle, and activ-
ity level to achieve their best blood sugar levels.
Mayo Clinic
The Mayo Clinic diet has two phases to help
people transition to healthier food and physi-
cal activity choices. The rst phase, Lose It,
is about changing key habits, not calorie count-
ing. The second phase, Live It, focuses more
on food groups and portion sizes. Overall, its
a well-balanced, healthful diet that incorpo-
rates nutrient-rich foods from all food groups
and reduces or eliminates excess fat, sugar, and
calorie intake [from less nutritious foods], says
Melissa Joy Dobbins, MS, RDN, CDE, CEO of
Sound Bites in Chicago.
Can it prevent or control diabetes? The Mayo
Clinic diet wasnt designed specically to prevent
or control diabetes. However, the majority of the
US News & World Report experts considered the
diets approach to be better than other diets for
this purpose.
5
require less than 10% of calories from fatno oils, seeds, nuts,
avocados, or olives; no more than 10 mg of cholesterol per day; meat,
poultry, and sh are to be eliminated; less than 2 T, or 24 g, of sugar per
day; no caffeine except green tea; low salt; no more than one alcoholic
drink per day; and include one full-fat serving of soy per day, says
Jessica Crandall, RDN, CDE, a dietitian at Sodexos Denver Wellness
and Nutrition program.
Can it prevent or control diabetes? The majority of research on the
Ornish diet has been conducted by Dr Ornish or by his team, therefore its
difcult to know the validity, Crandall says. In addition, the research has
been focused on heart disease as opposed to diabetes.
However, there was a study published in the American Journal of Health
Promotion in which Ornish dieters decreased their A1c levels by 0.4 per-
centage points after one year. Study participants with diabetes followed the
Ornish program and showed the same improvements in coronary risk fac-
tors and quality of life as those without diabetes. Participants also reduced
their diabetes medication.
6

Strengths and weaknesses: The diet is rich in healthful foods such
as fruits, vegetables, and whole grains, but its also extremely low in
fat, going against the recommendations for Americans, Crandall says.
The best candidate for the Ornish diet is someone who can maintain an
extreme diet with limited food options and can afford to purchase that
food, she says.
Anti-Inammatory
The anti-inammatory diet was developed by Andrew Weil, MD, best-
selling author, speaker, and integrative medicine specialist, and is based
on the Mediterranean diet. It follows the same nutrition guidelines as
the 2010 Dietary Guidelines for Americans and the American Heart
Association. Consume lowglycemic-load meals, lean protein, healthy
fatsbalancing omega-3 and omega-6and fresh produce, says Toby
Smithson, MSNW, RDN, LDN, CDE, author of Diabetes Meal Planning
and Nutrition for Dummies. The diet also recommends eating fewer
white potatoes, bread, crackers, chips, and pastries as well as sugar-
sweetened beverages. These carbohydrate foods also contribute to
inammation, Smithson says.
Can it prevent or control diabetes? Smithson agrees with the US News &
World Report experts and says, The guidelines fall in line with the poten-
tial to prevent and control diabetes since the overall recommendations
are healthful eating guidelines. However, she says the best method of
reducing inammation is through weight reduction and increased physi-
cal activity.
Strengths and weaknesses: The anti-inammatory diet doesnt prom-
ise or focus on weight loss. The recommended daily calorie range is from
2,000 to 3,000, depending on sex, size, and activity level. People with pre-
diabetes and type 2 diabetes typically require weight loss, and the anti-
inammatory diet wont guarantee weight loss with 2,000 to 3,000 kcal/
day and limited focus on physical activity, Smithson says, also pointing to
the diets high sodium content. A sample menu contained more than 3,000
mg of sodium, which is twice as much sodium as recommended for people
with diabetes, she says.
Moreover, Smithson says the lack of discus-
sion on physical activity is another weakness of
the diet. This eating plan is an overall health-
ful eating plan with inclusion of lean protein,
healthful fats, fresh fruits and vegetables, and
whole grain carbohydrates, she says.
Mediterranean
In 1993, the nonprot organization Oldways,
the Harvard School of Public Health, and the
European Ofce of the World Health Organiza-
tion introduced the Mediterranean diet along
with the Mediterranean Diet Pyramid graphic.
The Mediterranean diet is a largely plant-based
eating pattern based on the traditional foods and
drinks of countries surrounding the Mediterra-
nean, says Sara Baer-Sinnott, president of Old-
ways. The diet features fruits, vegetables, sh,
beans, nuts, and whole grains as well as other
ingredients such as olive oil and wine that have
been shown to promote good health.
Can it prevent or control diabetes? Accord-
ing to Baer-Sinnott, the diet has been studied
and noted by many leading scientists as one of
the healthiest in the world. In the last year, 10
studies have been published that document the
relationship between diabetes and the Mediter-
ranean diet.
In a large study published in the August 2013
issue of Diabetologia, researchers analyzed data
from more than 22,000 participants followed
for 11 years in the Greek cohort of the European
Prospective Investigation Into Cancer and Nutri-
tion study to explore the relationship among the
Mediterranean diet, glycemic load, and occur-
rence of type 2 diabetes. Researchers found that
people who consumed foods with a low glycemic
load that adhere to the principles of the Medi-
terranean diet have a 20% reduced risk of type 2
diabetes.
7

The ADA 2013 nutrition recommendations
suggest further research is needed to deter-
mine whether these study results and others
conducted in the Mediterranean region can be
generalized to other populations and whether
similar levels of adherence to the eating pattern
can be achieved.
Strengths and weaknesses: The Mediterra-
nean diet is easy to follow, affordable, and deli-
cious, and can be enjoyed by the entire family,
Baer-Sinnott says. Its lled with quality nutri-
ent-dense foods. Research has shown that
eating foods such as olive oil, nuts, and legumes
contribute to satiety, helping people feel full
THIRD PLACE WINNERS
3
Crunchmaster.com For recipe ideas and coupons, please visit us at:
plan. Results show these vegetarians have a lower rate of type 2 diabetes
than nonvegetarians. In this study, eating vegetarian also has been asso-
ciated with lower risk of overweight, insulin resistance, and metabolic syn-
drome, a precursor to type 2, she says. The research also shows that the
closer someone follows a vegan diet along the vegetarian spectrum, the
more health benets he or she will experience.
Strengths and weaknesses: According to Warshaw, following a veg-
etarian diet is easier today than ever before, but it still has its challenges.
People need to understand the challenges of following a vegetarian or
vegan diet up front, such as the shopping, cooking, and eating meals out,
she says.
No One-Size-Fits-All Pattern
Theres no magic to any eating plan or pattern for diabetes, Warshaw
notes. The best meal plan for diabetes is one thats individualized based
on health goals, personal and cultural preferences, access to healthful
choices, and a readiness, willingness, and ability to change.
Constance Brown-Riggs, MSEd, RD, CDE, CDN, is past national
spokesperson for the Academy of Nutrition and Dietetics, specializing in
African American nutrition, and author of the African American Guide to Living
Well With Diabetes and Eating Soulfully and Healthfully With Diabetes.
longer. We know that eating too much of any-
thing isnt healthful, so portion size and balance
are still key, she says.
Conversely, Brill says, No standard denition
of the Mediterranean diet exists, making it difcult
for many to follow. There are no suggested daily
intake guidelines or calorie-controlled options
and no recommended daily maximum sodium
level. To address this problem, Brill developed
the 10 Point Mediterranean Lifestyle Key
Component Checklist, which helps her patients
determine minimum and maximum amounts of
foods for this eating pattern.
8
Vegetarian
Vegetarianism is a broad term for an
increasingly or decreasingly rigid list of allowed
foods, with vegan the most narrow, Warshaw
says. The vegan diet excludes eggs, dairy, and
all other animal products. The exitarian,
Ornish, and Engine 2 diets are all part of the
spectrum of vegetarianism.
Can it prevent or control diabetes? Warshaw
points to the ongoing 1974 Adventist Health
Study of nearly 100,000 Seventh-day Adventists
as evidence of the benets of a vegetarian meal
For references, view this article on
our website at www.TodaysDietitian.com.
Gluten-Free
In
an effort to stay abreast of the latest trends, some
of the nations fast-food chains have introduced
gluten-free menus or menu items to cater to cus-
tomers. Like the large numbers of sit-down res-
taurants that offer gluten-free foods, fast-food
chains are nding that the demand for such fare
continues to rise, and theyre attempting to deliver. But there
are some important things clients and patients must know if
they plan to eat gluten-free fast food.
Burgeoning Trend
As the general population and the medical community
become more educated about celiac disease, an increasing
number of people are being diagnosed. Thats driving a trend
of increased demand for gluten-free food options. Restau-
rants are getting on board with this trend because of the fact
that one out of 133 Americans [1% of the population] is esti-
mated to have celiac disease, says Jim White, RDN, ACSM
HFS, owner and president of Jim White Fitness & Nutrition
Studios in Virginia Beach, Virginia, and a spokesperson for
the Academy of Nutrition and Dietetics (the Academy).
Joy Dubost, RD, PhD, CSSD, an experienced food scientist
and the director of nutrition and healthy living at the National
Restaurant Association, says theres no question the demand
is there. Eating a gluten-free diet has become very popular
for many reasons. People think they can lose weight or feel
healthier, and restaurants are in the business of providing
what customers want, she says.
White agrees that celiac disease isnt the only reason
many Americans have chosen the gluten-free route; weight
loss and overall health are two motivators. Diet trends
including Paleo, low carb, and antiwheat have all driven the
trend of gluten-free dining at restaurants, he says.
For many, its become a lifestyle choice. Unfortunately,
that choice sometimes is based on misinformation. As
much as 30% of the population reports eating gluten-free,
says Rachel Begun, MS, RDN, CDN, a food and nutrition
consultant and the author of The Gluten Free RD blog. Of
this 30%, more are eating gluten-free for nonmedical rea-
sons than those who have to eat gluten-free due to celiac
disease or nonceliac gluten sensitivity. I attribute this to
the health-halo effect.
Begun says that because celebrities and professional ath-
letes have endorsed a gluten-free diet for everything from
weight loss to improving athletic performance and even
overall health, the trend has really taken off. But she says
theres no evidence to prove that removing gluten from the
diet helps with any of this, and those who jump on the glu-
ten-free bandwagon for one of these reasons alone may not
be eating a healthier diet at all. The whole health-halo effect
of the term gluten-free often misleads people to assume
theyre eating a healthful diet when theyre not, Begun says.
Just because its gluten-free, doesnt mean its healthful,
she adds.
And thats certainly the case for fast food. Although fast-
food restaurants now are touting more gluten-free choices,
it doesnt mean the food is healthful. But many consumers
are duped into thinking thats the case simply because of the
association between gluten-free and the idea of good health.
This is an important area in which dietitians can educate cli-
ents and patients.
In addition, there are safety concerns of which clients
need to be aware. Theres always a risk of cross-contact
when restaurants are handling both gluten-free and gluten-
containing foods.
Safe Eating
Maintaining a strict, gluten-free diet isnt always easy for
clients, particularly if someone else prepares their food. If
youre eating gluten-free for a medical reason, such as celiac
disease, you have to be very careful any time you dine out,
says Marlisa Brown, MS, RD, CDE, CDN, president of Total
Wellness in Bay Shore, New York, and author of Gluten-Free
Hassle-Free and Easy Gluten-Free. A salad might be adver-
tised as gluten-free, but what if the person who handled
your salad forgot to change his or her gloves after handling a
sandwich [that contained gluten]?
White agrees theres always the risk of cross-contact or
cross-contamination when dining out. But in fast-food res-
taurants, it might be an even higher risk. Factors such as a
large amount of employee turnover and the hiring of younger,
less experienced food handlers can prevent consistency in
food preparation. In fast-food restaurants, its likely that the
workers havent had training on how to avoid contamination,
BY LINDSEY GETZ
Gluten-Free Fast Food
May I Take Your
Order Please?
he says. My best advice would be to keep the order simple and
be very explicit in your instructions.
Brown says that when it comes to fast-food dining, she
advises against the drive-thru and urges individuals with
celiac disease to go inside the restaurant and order their
food. The drive-thru poses more possibility for cross-con-
tamination to go unnoticed. With fast food, you often can
watch it being prepared because you can see the kitchen, and
you can ask questions face to face, she says. But thats only
if you go inside. Obviously that takes away a little from the
convenience factor, but its important to protect yourself.
Going inside the restaurant also allows clients to use common
sense. If you go through the drive-thru, you never get a look at
the inside of the place, Brown says. But if you walk inside, and
the restaurant is very poorly kept and you can see that the kitchen
area is a wreck, common sense dictates that theyre probably not
going to do the best job taking all the precautions with your food.
That would be a good time to choose a different restaurant.
In addition to scrutinizing the prep area, Brown says its
important for people to communicate their needs with restau-
rant staff members in advance and not wait for them to make
a mistake before speaking up. Explain that you will become ill
with the smallest amount of gluten, and ask that the food han-
dler change his gloves, she advises. Actually speaking to
someone in person is going to be your best chance of having a
safe experience. Trying to talk to someone through a drive-thru
window isnt good enough.
Dubost agrees that communication is key any time clients
dine out. Go inside and talk to a manager or server to ensure
theyre fully aware of your needs, she says. But also have a
Gluten-Free Offerings at Fast-Food Chains
Burger King
Four years ago, Burger King revealed a gluten-sensitive list
as part of its BK Positive Steps campaign to provide more
nutrition information on the chains menu items. The com-
pany also switched ingredients to make its fries gluten-free.
Although celiac disease patients have several choices, rang-
ing from the Whopper patty to the Tendergrill chicken let,
the chain does note that fried items may still be fried with
gluten-containing ingredients. Clients can nd the full list
at www.bk.com/cms/en/us/cms_out/digital_assets/les/
pages/MenuGlutenFree.pdf.
Chick-l-A
Chick-l-A has provided information about allergens and its
gluten-free offerings on its website (www.chick-l-a.com/Food/
Allergen-Gluten-Diabetic). Gluten-free diners can choose the
Chargrilled chicken let (no bun) or nuggets and several sides
to avoid eating gluten. However, the chain makes it clear that it
doesnt have a gluten-free prep area in its kitchens.
KFC
Known for its fried chicken, individuals with celiac disease and
nonceliac gluten sensitivity will nd it difcult to eat at KFC
because all of the fried chicken items and the sandwiches con-
tain gluten. Diners may be able to choose from the side dishes
or salads. The information is available online at www.kfc.com/
nutrition/pdf/kfc_allergens.pdf.
McDonalds
McDonalds doesnt offer a gluten-free menu nor does the
chain list gluten-free menu items. The chain encourages
customers to visit its website and review all ingredients, since
they change periodically. McDonalds also urges customers to
seek physician guidance due to the individualized nature of
food allergies and food sensitivities. Ingredient information
can be found at www.mcdonalds.com.
Taco Bell
Taco Bell has information listed on its website under the
Food Allergens & Sensitivities tab (www.tacobell.com/
nutrition/allergens). A few of the gluten-free choices are
the Cantina Bowls and sides. Like other chains, Taco Bell
warns that gluten-free food may be prepared on the same
equipment as gluten-containing food.
Wendys
Wendys publishes a link to its gluten-free menu on its
website (www.wendys.com/redesign/wendys/pdf/en_US_
gluten_free_list.pdf). Its signature sides such as chili and
the baked potato both are on the list as well as several
salads and meats.
LG
plan before you even get there. Look at their menu online and
know what gluten-free options are available.
Although reading menus ahead of time and going inside the
restaurant vs. using the drive-thru seem to defeat the purpose of
fast food, these are important steps for clients to ensure safety.
Brown says doing advanced planning is easier than ever before
with advances in technology and the many gluten-free menus
available online. There are now apps available that can help you
nd restaurants with gluten-free options even when youre out
and about, she says. An app allows you to look things up quickly
and still get the convenience factor of eating on the go. Its not
like you have to do your research at home. Smartphones make it
a lot easier to eat gluten-free on the road.
Consumers who eat fast food need to remember that even if
they did their homework about a restaurant in the past, theyll
need to do it again because menus are subject to frequent
changes. This is why some fast-food restaurants dont commit
to offering gluten-free food. Some restaurants such as McDon-
alds dont have a gluten-free menu because they frequently
change their ingredients, White says. Its always a good idea to
check the websites the day youre going somewhere in order to
make sure that what youre selecting truly is gluten-free.
Cindy Goody, PhD, MBA, RDN, LDN, senior director of the
nutrition/menu innovation team for McDonalds USA, says
the chain always encourages diners to visit its website for
the most current information available, particularly since
ingredients periodically change. At this time, Goody says the
chain doesnt offer a gluten-free menu or list of items but does
encourage customers to do their own research. By accessing
the ingredient statement listing on our website, individuals
can determine if there are any ingredients or food allergens
to which theyre personally sensitive, she says. But we also
want you to know that despite taking precautions, normal
kitchen operations may involve some shared cooking and
preparation equipment, areas, and utensils, and the possibility
exists for food and beverage items to come into contact with
other food products, including allergens.
Choosing a Restaurant
The potential for cross-contamination is a common sce-
nario. Begun says that many restaurants offer gluten-free
items on their menu but arent taking the extra steps needed
to separate gluten-free food preparation areas from the gen-
eral preparation areas. However, there are some restaurants
that take serving gluten-free foods seriously. They go the
extra mile to train employees about preventing cross-contact
in the kitchen and front of house. The fact that a restaurant
trains its employees in this regard may not be advertised, but
according to Begun, its easy to determine. To the person
that has to avoid even the smallest amount of gluten, its usu-
ally pretty obvious if the restaurant associates have been
trained, she says.
Which restaurants have the best employee training pro-
grams varies, but in general, Angela Lemond, RDN, CSP, LD,
a wellness coach in Plano, Texas, and spokesperson for the
Academy, says specialty restaurants may know more about
their ingredients if they make foods from scratch because they
know exactly whats in them. Of course, thats not the case with
fast-food restaurants. In general, chain restaurants have a
tendency to have more premarinated or preseasoned foods that
just need to be heated up, and those foods will have many more
questionable ingredients, she says.
However, one positive about fast-food menus is the consistency
of ingredients from chain to chain. Chains may have more of a uni-
versal ingredient menu produced from a national headquarters,
which is helpful in determining whats in a menu item, she adds.
Of course, Lemond notes that it ultimately comes down to
the people working at a particular restaurant, as they deter-
mine whether individuals who must avoid gluten can safely
eat there. The bottom line is that having a successful din-
ing-out experience is largely impacted by the individuals will-
ing to work with you at the specic restaurant you go to, she
says. They need to have the knowledge to decipher their own
menus ingredients.
Some fast-food restaurants do a better job of promoting their
gluten-free message than others and therefore are more popu-
lar with people who have celiac disease or nonceliac gluten sen-
sitivity. But even that doesnt always mean theyre doing a better
job of preparing gluten-free items. Diners who must eat gluten-
free still need to do their homework and ask the right questions.
White says that Wendys appears to be a popular choice for
gluten-free dining, and the chain has done a good job promoting
their gluten-free items. According to Wendys, their trademark
baked potato is gluten-free as well as their chili and the popular
chocolate and vanilla Frostys, White says. The salads can be
ordered without the croutons, although for true celiac patients
this may not be good enough. Most of their salad dressings are
also gluten-free.
What Lies Ahead
While the gluten-free food trend is booming, Dubost says
when the FDA begins enforcing regulations surrounding the
denition of gluten-free this month, the number of restau-
rants boasting these options may decrease. They will have
to comply with strict regulatory denitions, and for some,
that simply may not be worth the risk, she says. Its not
easy for restaurants to ensure a gluten-free dining expe-
rience. They can work with their suppliers and their ingre-
dients, but theres also prep and handling to worry about.
Those that continue to offer gluten-free options are going to
be those that are truly committed.
Lindsey Getz is a freelance writer
based in Royersford, Pennsylvania.
A Review of the Benets of Probiotics, the Top Sources,
and Whats New in the Dairy Case
By JULIANN SCHAEFFER
Dairy
s
Probiotic Power
t any given time, hundreds of species of
bacteriaboth potentially harmful and
potentially helpfulinhabit the human
digestive tract. Probiotics are the friendly
types that help to ferment, decompose,
and digest the foods we consume.
Thus far, research has suggested that theres potential in
how certain probiotic strains may help aid certain ailments.
Research has shown that certain strains of bacteria may help
promote good digestion (eg, lactobacillus and bidobacterium),
boost the immune system (eg, Bidobacterium bidum and
Streptococcus thermophilus prevented rotavirus infection),
and ght infections (eg, Lactobacillus GG to treat Clostridium
difcile), says Sherry Coleman Collins, MS, RDN, LD, owner of
Southern Fried Nutrition Services in suburban Atlanta.
Whats more, research is examining probiotics potential
effects on digestive disorders such as irritable bowel syndrome
(IBS) and inammatory bowel disease (IBD) as well as how
a certain strain of the benecial bugs even may help lower
cholesterol. Probiotics have a very good safety record and
have been successfully used with patients suffering from
a variety of illnesses and compromised immune systems,
Collins says, adding that she still recommends that all clients
who are interested in starting a regular probiotics regimen to
treat disease rst consult their physician.
Though Collins notes that the current evidence may support
probiotic consumption for many different health benets, she
cautions that the research has yet to conrm these ndings
since there arent studies looking at deciencies among
those who dont consume probiotics, she says.
Joanne Slavin, PhD, RD, a professor at the University of
Minnesota and a nutrition researcher, agrees: We dont have
great intake data on probiotics, so its difcult to show rela-
tionships between intake of probiotics and health outcomes.
Since there are no universally accepted methods to measure
probiotic intake, she says this also makes it difcult to rank or
compare products.
Nevertheless, its well known that dairy is one of the main
healthful sources of probiotics, with yogurt being the most pop-
ular among consumers. And if probiotic curiosity leads more
people to include yogurt in their diet, Slavin says that isnt bad.
Here, dietitians discuss dairys probiotic prowess, which prod-
ucts are the best sources, and whats new in the dairy case.
Dairys Benets
Dairy is one of the most regularly accessible and acceptable
food categories that contain probiotics, Collins says. That, with
its overall nutrient prole, makes it a great form in which to
consume probiotics. When working with clients, I always try
to encourage them to choose foods that are nutritionally dense,
and dairy is one of those foods, she says.
In addition, theres some evidence that foods that provide
probiotics and prebiotics [nondigestible parts of foods that
become fuel for probiotics] may enhance mineral absorption,
she adds. Therefore, eating yogurt and other probiotic dairy
foods may help ensure that calcium and other minerals in
dairy yogurt are absorbed.
Yogurt also is a great vehicle for getting probiotics, Collins
says, because of the nutrient prole of cows milk. And for
people, particularly kids, who dont like milk, yogurt provides
another way to get the vitamins and minerals in cows milk
into their system. While many things [such as sauerkraut,
miso, and tempeh] can be fermented to produce healthful
live active cultures, cows milk packs a powerful vitamin
and mineral prole along with the gut-restoring probiotics,
says Christa Byrd, MA, RD, a clinical dietitian at Beaumont
Health System in Royal Oak, Michigan. [But] yogurt is better
tolerated by people who are lactose intolerant because the
bacteria digest the lactose or milk sugar while fermenting
the milk, which produces increased lactic acid and decreased
lactose. According to Slavin, yogurt is particularly benecial
for children who dont like the taste of cows milk because
yogurt provides high-quality protein, vitamin D, and calcium.
According to Kristin Kirkpatrick, MS, RD, LD, manager of
wellness nutrition services at the Cleveland Clinic, yogurts
accessibility and familiarity make it a great starting point for
most people looking for probiotics, and many varieties offer
a big probiotic punch. Yogurt and ker will have the most
probiotics, she says.
Because heat kills the bacteria in yogurt, Kirkpatrick
recommends researching whether a particular brand has
been heated after production or just look for the live and
active cultures seal to ensure theres enough probiotics to
provide any potential benet. Yogurt and most probiotic-
containing drinks arent heated before serving, so theyll be
the most reliable sources, she says.
Whats New on Store Shelves
As the media spotlight continues to shine its healthy halo on
the probiotic buzzword, food companies continue to offer con-
sumers new ways to get their daily dose of the benecial bugs.
New yogurt avors, single-shot probiotic drinks, and frozen
ker bars are just a few of the new forms probiotics are taking
at the grocery store today. Dietitians speak out on the latest
probiotic dairy trends as well as provide tips on how to recom-
mend clients incorporate these bugs into their daily meals.
Yogurt
Because yogurt is available in every supermarket and
many convenience stores and even fast-food restaurants,
Americans have easy access to probiotics via this favorite
food, Collins says.
By far, yogurt also offers the most avor and texture
options. Even so, she says its important to consider quality
when surveying for probiotic content. While yogurt may be
available almost everywhere, the practitioner should know
A
that good-quality yogurt with multiple strains of bacteria and
live, active cultures must be eaten to get the best benet,
Collins says. Bacteria in foods is sensitive to time and tem-
perature, so if its improperly stored, the bacteria may not be
alive or in adequate amounts to be of benet.
Yes, yogurt generally has the greatest amount of probiotic
content, says Janet Colson, PhD, RD, a professor of nutrition
and food science at Middle Tennessee State University in
Murfreesboro, but bacteria strains and numbers will vary by
brand, so she recommends clients know their yogurt before
purchasing. The ingredient label indicates the strain but not
the number of bacteria, she notes.
In general, Colson says the number of live bacteria likely
will decrease as the yogurt sits in the refrigerator, so fresh is
best. In some cases, the bacterial content increases [as yogurt
sits], which depends on the strain of bacteria, she says, noting
that this isnt the case for the majority of probiotic-containing
yogurts. The bacteria Lactobacillus rhamnosus (found mainly
in Stonyeld yogurt varieties) tends to be more stable during
storage than other bacteria.
Colson says the leading yogurt trend shes seen lately is the
increased types of bacteria that food companies are offering
in yogurt varieties as well as additional avor options. Lacto-
bacillus bulgaricus and Streptococcus thermophilus are the only
two cultures required by law to be present in yogurt. However,
many yogurts have more than these two, she says.
Greek yogurt continues to increase in popularity, so its
no surprise that many of the latest product innovations are
coming from Greek (or similar) varieties. According to Byrd,
Greek yogurt is her go-to patient recommendation, particularly
for wound healing. When dealing with underweight patients
in the clinical setting who have increased protein needs for
wound healing, yogurt is my No. 1 supplement recommenda-
tion, especially Greek yogurt, which packs a powerful 13 g of
protein per 100-kcal serving, she says.
Yogurt is a great option because pressure sores and
unintended weight loss are commonly seen in the elderly,
who also are more likely to be lactose intolerant, she adds.
The low-lactose prole of yogurt makes it helpful and easy
to digest. Yogurt also is a low-cost supplement, which is easy
to nd in a variety of avors that patients can easily continue
[to consume] at home.
In addition to the starter cultures, Stonyeld products con-
tain three other probiotic cultures: Lactobacillus acidophilus,
Bidus, and Lactobacillus casei. Stonyeld, which recently
introduced a creamier texture to its line of organic Greek
yogurt, now offers two new avors: Black Cherry and Caf
Latte. Cobranded with Happy Family, Stonyeld also recently
launched yogurt pouches for the younger set under the pre-
existing brand names YoBaby, YoTots, and YoKids, all of which
contain the same probiotic strains as its other yogurt products.
YoBaby pouches offer whole-milk yogurt in four varieties,
including Blueberry and Mango, with sh oilsourced DHA and
EPA omega-3 fatty acids. YoTots offers a similar yogurt for-
mulation with slightly more adventurous veggie-fruit options,
such as Pear Spinach Mango, meant to introduce toddlers to
new avors. And YoKids pouches feature low-fat yogurt in
Blueberry, Strawberry, and Strawberry Banana avors.
Three Happy Cows, another Greek yogurt company
that uses a blend of probiotic strains, recently launched
Strawberry, Blueberry, Caramel, and Vanilla Bean avors,
with 11 to 12 g of sugar and 15 g of protein in each serving.
Greek yogurt manufacturer Chobani, which includes three
strains of probiotics in all of its products, introduced a range
of new options this summer. In addition to a dessertlike full-
fat line called Chobani Indulgent, the company is offering a
new line called Chobani Greek Yogurt Oats, made with real
fruit and whole grain steel-cut oats for added ber.
For weight-conscious consumers, Chobani Simply 100
Greek Yogurt offers 100-kcal varieties in Key Lime and Pine-
apple Coconut, and Chobani Kids offers kids a low-fat, low-
sugar Greek yogurt line with avors such as Grape and
Watermelon. Chobanis Seasonal line, with Watermelon and
Pink Grapefruit highlighting the summers freshest avors,
also is new, as is its 4% whole milk Chobani Kitchen, which is
touted as perfect for baking.
A relative newcomer to the yogurt section, Noosa Yoghurt
describes itself as an Aussie-style yogurt thats plenty thick
and paired with fresh fruit pures and honey in addition to a
blend of probiotics. Its yogurts contain a blend of ve cultures
(the same strains Stonyeld products offer) and new avors
include Pineapple and Coconut as well as a Plain variety.
For clients who cant (or choose not to) eat dairy, Kirkpatrick
says there are soy- and coconut-based yogurts that also provide
probiotics. Byrd likes Trader Joes Coconut Yogurt for people
with a milk protein allergy. Its a good fermented snack with
active cultures, although it contains a little less protein than
other yogurts, she says.
With so many new brands and product lines lling the
yogurt case, where should clients look for the most benet?
According to Colson, the most important thing is to guide
clients toward live, active cultures rst and low sugar next. I
personally only select plain fat-free yogurt and use it in place
of sour cream on vegetables or a casserole and for whipped
topping on fruits, she says.
Research has yet to determine which probiotic strains can
elicit specic benets, but Colson says when it comes to look-
ing at ingredient labels, the more bacteria strains a yogurt
contains, the better. (Both Stonyeld and Noosa yogurts con-
tain ve strains, whereas many varieties offer two to three.)
I would avoid selecting a yogurt that has too many added
sugars, candy, or cookiesbasically, the dessert type, she
adds. People can easily gain an excessive amount of weight
by eating yogurt for the health benets and end up having so
much added sugar and fat that the detriments outweigh any
possible health benets.
2014 NASPGHAN Nutrition Symposium
Saturday, October 25, 2014 Hilton Atlanta, Atlanta, GA
Explore our resources for you,
your patients and families:
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We are pleased to announce the launch of
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Its also easy for clients to spend more cash than they
intended when looking for new yogurt options, but Kirkpatrick
says a steady eye can solve that problem. She tells clients to
read the ingredients. Buying an off-brand yogurt containing
the same species of probiotics as the name brand will still
provide the same benet. She also notes that yogurt can
be the most cost-effective way to get their daily probiotics,
if consumers shop carefully.
Collins agrees: There are some store brands that are as
robust in the strains of bacteria as the more expensive name
brands. Looking for sales and coupons is always a good tip for
saving bucks at the grocery store.
Probiotic Dairy Drinks
While not as widely known or loved as yogurt, the yogurt-
like probiotic drink ker is gaining in popularity. Collins says
ker is available in most supermarkets and specialty nutrition
stores, and with far more strains of bacteria than yogurt, she
says ker is a delicious drinkable dose of probiotics. Ker
typically contains 10 different strains of bacteria, she says.
Lifeway, which makes a range of ker products that all
offer its blend of 12 probiotic cultures, has introduced a few
ways for people to enjoy its probiotic drinks. Veggie Ker
is a savory alternative to fruit-avored kers. A new blend
of vegetable juices and ker, it delivers one full serving of
vegetables as well as the full nutritional kick of ker per 8-oz
glass. It comes in Tomato, Cucumber, and Beet varieties.
Lifeways Ker With Oats provides consumers with 1.5 g
of soluble oat powder mixed with ker. With a smooth
texture and a hint of oat avor, Ker With Oats offers 11 g
of complete protein in breakfast-friendly avors such as
Blueberry Maple, Cinnamon Apple, and Vanilla Plum. For
clients watching their sugar intake, Lifeway offers Perfect
12 Ker, which is sweetened with stevia and has no added
sugar and only 12 g of carbs.
In addition to kers, there are drinkable yogurts available
that offer probiotics as well. California-based GlenOaks Farms,
which debuted the rst drinkable yogurt in the 1980s, recently
introduced GlenOaks Drinkable GREEK STYLE Yogurt, offering
more protein in addition to its live and active cultures in Peach,
Raspberry, and Strawberry avors.
Collins also has seen a trend in drinkable yogurt products
specically designed to be probiotic shots that pack lots of
probiotics into small quantities. One such option is Bio-K+,
a liquid probiotic that uses dairy, soy, and rice to make its
formula of 50 billion bacteria, which it packs into a single-
serving shot of sorts. The bottle is more akin to the size of a
small yogurt container and can be consumed in one serving.
Or individuals can consume one-quarter to one-half of the
drink at a time and still reap the probiotic benets.
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Cheeses and Spreads
Even though all cheese (except processed) is fermented,
Byrd says, that doesnt mean all varieties contain probiotics,
and those that do may not survive conditions in the gastroin-
testinal tract. Because of this, she says its just as important
for clients to check the labels for live and active cultures on
any product they believe has probiotic cultures.
A relatively new player in the probiotic category, and a
potentially new way to entice clients to consume probiotics, are
yogurt and cream cheese spreads. Sonya Angelone, MS, RDN,
CLT, a spokesperson for the Academy of Nutrition and Dietet-
ics, likes the cream cheese and yogurt spread from Green
Mountain Farms, which comes in individual 1-oz containers for
convenience. Although a bit more expensive than buying one
large container and portioning out a serving, it may make the
difference between eating it and not eating it, she says.
Angelone likes suggesting clients try the spread on bagels,
wraps, sandwiches, celery sticks, and even in smoothies.
Whereas regular cream cheese provides about 10 g of fat
and 1 g of protein with 100 kcal/oz (with no probiotics), Green
Mountain spread has 4 g of protein, 3.5 g of fat, and 60 kcal/oz
with live and active cultures, she says.
For fruit acionados, discount retailer Aldi recently rolled
out a Greek yogurt fruit dip that blends Greek yogurt and
cream cheese and contains live and active cultures. In two
avors, Strawberry and Vanilla Bean, each serving provides
4 g of fat, 2 g of protein, and 70 kcal.
Karoun Dairies also introduced its healthier alternative to
cream cheese called Blue Isle Mediterranean Yogurt Spreads.
Similar in consistency to cream cheese, the spreads contain
6 g of fat, 1 g of protein, and 60 to 70 kcal in addition to its pro-
biotic blend. Blue Isle spreads come in ve varieties: Blue-
berry, French Onion, Honey, Original, and Spicy Vegetable.
Karoun Dairies also offers a line of avored soft yogurt
cheeses called Karoun Labne. This line of Mediterranean-
style spreadable cheese also contains live and active
cultures and comes in Creamy Ranch, French Onion, and
Spicy Garden Vegetables.
Frozen Offerings
The frozen foods aisle also contains probiotic-containing
dairy products. Frozen Greek yogurt has become very
popular, and frozen ker is now available, Kirkpatrick says.
Various companies, including Lifeway, are offering frozen ker
bars/ice creams, but Kirkpatrick cautions clients and patients
who may want to consume such tasty-sounding products as
the main source of their probiotics.
While noting that frozen products still can have the live and
active cultures seal if they contain enough viable bacteria per
gram at the time of production, she urges clients to see such
ice creamlike options for what they are: dessert. I wouldnt
recommend these as a main source of probiotics. Theyre
desserts and should be consumed in moderation, she says.
Counseling Takeaway
Whether clients seek to get their probiotics from a single-
serving shot, a spoonable yogurt, or even a spread on their
morning bagel, Byrd says her advice to clients is similar: Look
to include fermented foods in your diet three times per week,
and avoid added sugars whenever possible. Use caution with
products containing increased sugar, as this may not only
add empty calories, but it may negate some of the healthful
gastrointestinal benets, she says. Excessive sugar intake
also can disrupt the balance of healthful bacteria that works
to breakdown and digest the foods we eat by increasing the
gas-producing [bloating] fungal inhabitants.
In general, Collins recommends most clients consume
6 to 8 oz of plain yogurt or 4 oz of ker per day to maintain
good digestion, upping that recommendation to twice per
day if a client seeks to prevent antibiotic-induced diarrhea,
for example.
I recommend my clients choose a yogurt with the most
different strains of bacteriave or moresince different
bacteria seem to have different positive health benets, she
says. Buying the freshest yogurt available helps ensure live
and active cultures, and avoid those with added stabilizers
and gelatin, since quality yogurt doesnt need those added
ingredients to be thick and creamy.
Juliann Schaeffer is a freelance writer
and editor based in Alburtis, Pennsylvania,
and a frequent contributor to Todays Dietitian.
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Learn What It Takes to Get Started and Become Successful
By LORI ZANTESON
Building a Career Through
Public Speaking
sk nutrition professionals today how theyre pro-
moting their businesses and brands and spread-
ing nutrition messages, and most will probably
tell you theyre doing this through social media
outlets such as Facebook, Twitter, and Pinterest;
websites; blogs; videos; and even writing books. Others will
say theyre taking advantage of public speaking opportunities
as well to further expand their professional inuence, boost
their income, and take their careers to a higher level.
Many dietitians start small by speaking at venues such as
local and regional conferences, neighborhood hospitals, non-
prot organizations, schools, local chambers of commerce,
community education events, and faith-based organizations.
Many participate in public seminars, webinars, and corporate
speaking and eventually go on to deliver keynote addresses
and presentations at national meetings.
Todays Dietitian interviewed RDs with public speaking experi-
ence who discuss what it takes to get started, how to set goals,
and the importance of choosing a specialty for long-term success.
Taking the First Step
Because there are many different public speaking paths
dietitians can take to complement their business, including
becoming a consultant or coach, its best to determine what
you want to accomplish and set business goals. Do you
want to get more clients, diversify your revenue, increase
exposure? asks Stacy Tetschner, CAE, CEO of the National
Speakers Association in Tempe, Arizona.
According to Michelle May, MD, CSP, a Phoenix-based
motivational wellness speaker, the founder of Am I Hungry?
Mindful Eating Programs and Training, and the author of
Eat What You Love, Love What You Eat: How to Break Your Eat-
Repent-Repeat Cycle, dietitians need to ask themselves why
they want to do public speaking. Everyone always has to start
with why. You have to know why because that helps nd your
audience, she says.
For example, if a dietitians goal is to build her practice, she
can look locally for prospective clients at community events,
mothers groups, support groups, or corporate lunch and learns.
A dietitian is well qualied to speak at these [venues]. Being a
dietitian is the perfect segue into a variety of topics, May says.
A retired family physician, May had a medical practice for
16 years. When she started the mindful eating program Am I
Hungry? in 1999, she gradually transitioned to become a full-
time entrepreneur, helping others run mindful eating pro-
grams. She started speaking publicly to health professionals
in 2000 to share information about mindful eating and how it
could help their patients and clients as well as at community
and corporate wellness events and at many other programs to
help individuals. We also train dietitians in mindful eating, so
I speak at RD events. They might follow up with our facilitator
training program or have patients or clients to refer to our
programs or books, she says.
As a member of the Arizona Academy of Family Physicians,
May spoke at local chapter events, where she received valuable
feedback while honing her speaking skills. She eventually
applied to speak at the national convention, where shed speak
for the next 10 years. May recommends RDs turn to the Academy
of Nutrition and Dietetics (the Academy) to get public speaking
experience, starting with the local chapter and moving up to the
state and eventually the national level.
Find Your Niche
Once dietitians have established why theyd like to do
public speaking, its important to develop a specialty for which
theyd like to be known. Academy members can participate
in the Speakers and Media specialty group, which is part of
the Nutrition Entrepreneurs Dietetic Practice Group (DPG)
composed of dietitians looking for support and mentoring
from colleagues who are doing the same thing. (The speakers
group has a mailing list, publishes newsletters, and provides
networking opportunities with other practice groups at the
Food & Nutrition Conference & Expo [FNCE].)
Karen Collins, MS, RDN, CDN, FAND, a speaker, writer, and
consultant and the nutrition advisor for the American Institute
for Cancer Research (AICR), joined this group early in her
career. In fact, it was during one of the speakers meetings at
FNCE that Collins was encouraged to specialize in a certain
aspect of nutrition. At rst I wanted to be broad, but in order to
be a speaker, [you should] be an expert on something, a subject
matter such as weight control or a group like the elderly, kids,
or people in business. I think its valuable to have a niche, she
says. Eventually, Collins specialized in cancer.
Early in her career, Collins spoke at group classes and
hospital events and as a clinical instructor at Cornell Univer-
sity, all of which helped build her condence. Becoming the
nutrition advisor for the AICR transitioned her from small to
much larger conferences and audiences. Its a great way to
reach out to people, she says.
Over the years, as health professionals and cancer sur-
vivors heard Collins speak publicly about the disease, she
established herself as an expert and built a good reputation.
You have to have that expertise and speak on what you
already know, she says. Theres something thats very
genuine. The audience can sense that your expertise comes
from research and practical experience.
Now that Collins is well established in her career and as
a presenter, people approach her with speaking opportuni-
ties. Even if she presented the topic before, Collins says she
always customizes it to meet the needs of the audience. You
have to research the group, look on their website, and talk
to people in the group to assess what they need and want to
know about a topic, she explains. It takes a lot of time to
craft a good proposalbefore you even get the joband then
more time shaping a presentation that each particular audi-
ence will nd truly memorable.
A
Getting Paid
When dietitians are hired to speak, its important for them
to determine how much theyre worth. I spend enormous
amounts of time preparing for presentations, Collins says,
including research and guring out how to condense it, the
take-home message, and the PowerPoint slides.
Tetschner suggests dietitians consider what they earn
annually as an RD, determine how much time theyd have to
give up to speak, then gure out how many times per year
theyll need to speak at a particular rate to net the amount
of money they want to earn in one year.
However, dietitians shouldnt expect to get paid for public
speaking when theyre just starting out. In fact, many RDs
begin speaking for free. A person should never do paid
[speaking] until he or she has done a ton of free [engage-
ments]. Your reputation as a speaker is only as good as your
last speech. Get really good and comfortable on the platform.
No one will pay good fees for a so-so speech, May says.
David Grotto, MS, RDN, LDN, president and founder
of Nutrition Housecall in Chicago and author of The Best
Things You Can Eat, 101 Foods That Could Save Your Life, and
101 Optimal Life Foods, agrees that speaking in front of as
many audiences as one can is the most valuable way to
get experience. I did a lot of freebies in the beginning, he
says. Early on, Id speak for fooda meal provided with the
eventin the hopes of drumming up my private practice. It
can be a great public relations tool that may pay off in client
referrals down the line.
Unpaid speaking also can be lucrative in other ways. Grotto
has experienced his audience members looking for dynamic
speakers, which has led to more speaking opportunities. Hed
ask these audience members to provide testimonials and
make referrals that hed use as marketing tools to get hired
for other speaking events. Its worth its weight in goldbetter
than a PR company, he says.
Another way to capitalize on free public speaking is to have
a book to sell at the event, otherwise known as back-of-the-
room sales. During speaking engagements, many dietitians
sell books theyve written and do well. I found that my rst
book became a living, breathing business card for me, Grotto
says. Being an author has huge appeal when people are
looking for a speaker, adding that hes seen self-published
books bring in six gures from back-of-the-room sales.
For authors who have publishers, arrangements can be
made to allow the group or organization to buy several books at
the wholesale price (typically 50% less than retail), and sales
at the event would go toward supporting the organization. Its
a win-win. You get credit for book sales, and youre helping the
event, Grotto says.
Speaking for free often is easier to accept when you feel
honored for being invited, says Barbara Ruhs, MS, RD, LDN,
a retail food and health marketing communications specialist
and former supermarket dietitian who currently operates
the consulting business NeighborhoodNutrition.com. The
event administrators may waive your conference fee and
offer other perks, she says. Its always been about education
and opportunities. Ive been a leader in creating education
opportunities for other supermarket dietitians. Others know
this and seek me out, she says.
In fact, Ruhs once received an all-expenses-paid trip to
Japan to learn about probiotics and an invitation to tour behind
the scenes at Grimmway Farms to see how they harvested
carrots. They know Im vocal in this area and talk to lots of
dietitians, she says.
Resources for Speakers
Organizations Supporting
the Public Speaking Business
National Speakers Association (www.nsaspeaker.org):
Provides resources and education designed to advance
the skills, integrity, and value of its members and the
speaking profession. There are state and regional
chapters throughout the United States.
Nutrition Entrepreneurs Dietetic Practice Group
(http://nedpg.org/about), speakers and media specialty
group: Represented in all 50 states, this group provides
colleague support in the business of speaking profes-
sionally on wellness and nutrition topics.
Training
Toastmasters International (www.toastmasters.org):
Members improve their speaking and leadership skills by
attending one of the more than 14,000 clubs worldwide.
Public speaking classes at your local university or
community college
Books
Power Speak by Dorothy Leeds
Made to Stick by Chip Heath and Dan Heath
Websites
Six Minutes: Speaking and Presentation Skills
(http://sixminutes.dlugan.com): This site provides tips
and strategies for developing presentation skills and
becoming an effective and condent public speaker.
TJ Walker (www.tjwalker.com): Walker is the host
of the top-rated YouTube channel devoted to public
speaking and media training improvement. This site
features helpful videos that address various aspects
of public speaking skills.
As a coordinator for the Nutrition Education and Training
Program, which is under the Child Nutrition Act, it was part
of Ruhs job to teach school foodservice professionals how
to comply with the National School Lunch Program nutrition
guidelines. She has hosted conferences for dietitians and
has had many television and print media opportunities. In
public health, youre always looking for ways to maximize your
impact. Media is a way to reach a lot of people, she says.
When Ruhs became a supermarket dietitian 14 years ago, it
was a natural t. The media reached out to her as a local voice,
and it was good marketing for both Ruhs and the supermarket
for which she worked.
She says the most important part of public speaking is
sharing what shes learned with others. When she started
her career as a supermarket dietitian, she saw a need for
resources that would help supermarket dietitians do their
jobs in the communities they served to the best of their abili-
ties. She saw the opportunity to specialize in a particular
niche, became the expert she was seeking, and now people
seek her as a public speaker for supermarket dietitians.
While becoming an expert helps garner more speaking
engagements, theres much more to public speaking than
meets the eye. You build up a reputation, but you have to be
relevant; you have to be front of mind, Grotto says. In other
words, you need to market yourself.
Grotto was busy completing his masters degree program
last year and noted the decrease in speaking engagements
compared with the year before when he was actively promot-
ing himself and doing more public speaking. You never stop
pitching. You have to get out there, he says.
Honing the Craft
While speaking in front of audiences comes naturally for some
dietitians, it doesnt for others. Fortunately, there are plenty of
resources to ne-tune and master the skill of public speaking.
Toastmasters International, a world leader in communication
and leadership development, helps professionals develop speak-
ing skills and gives them practice in front of an audience.
Of course, theres no better teacher than getting experience
speaking in real life situations. Ninety percent is the way you
say it, 10% is what you say, Grotto says. The thing that seems
to work the best is repetition. Youll develop your style, adding
that he recommends nutrition professionals watch other
speakers and note what they do that audiences enjoy.
In addition to the Nutrition Entrepreneurs DPG, the National
Speakers Association can show professionals how to use
speaking to make a living. We help people gain the tools
the education and the professional communitythey need,
Tetschner says, noting that people dont have to do this on
their own. There are 3,000 members of the organization who
make speaking a full-time business. Those just starting out
can nd out whos doing what theyd like to do and learn from
their experiences, he says.
Dietitians have expertise that people are interested in, May
says. Speaking is a great way to help people, build your busi-
ness, and help serve. Dietitians need to set business goals,
determine the ideal audience for their niche topic, and pitch it,
she says. Start small and speak for free to get the experience
and keep at it. Public speaking can give dietitians higher pro-
les that can open doors and opportunities that not only can
build their business and brand but elevate their careers.
Lori Zanteson is a food, nutrition, and health writer
based in Southern California.
Venues for Speaking
Opportunities
Michelle May, MD, CSP, a Phoenix-based motivational
wellness speaker, offers these suggestions:
Adult education programs
Businesses, small and large, local and national
(or international)
Chambers of commerce
Charity fundraisers
City visitors bureaus, meetings, and conventions
listings
Clubs (eg, womens, business, special interest)
Colleges and universities
Community education
Conferences and conventions
Continuing education
Corporate training programs
Corporations
Cruise ships
Employee wellness programs
Faith-based organizations
Governments
Hospitals
Lunch and learns
Nonprots
Professional or industry associations (Check out
the Gale Encyclopedia of Associations which includes
listings such as annual budget; upcoming state,
regional, and national conferences; publications;
and contact information.)
Public seminars and workshops
Schools, for kids, parents, teachers, and the
administration
Service groups
Sponsored speeches at conferences and conventions
Trade shows
Youth/childrens organizations
CARING FOR TODAYS
CANCER SURVIVORS
By Karen Collins, MS, RDN, CDN, FAND
Appropriate nutrition and physical activity
recommendations can enhance their
long-term health and quality of life.
Many dietitians likely will work with cancer survivors at some
point in their careers.
1,2
As a result of multiple factors, includ-
ing earlier detection and more effective treatments, 65.8% of
cancer survivors today have passed the classic ve-year sur-
vival marker,
3
and 40% have survived 10 years or more.
2

These survivors face myriad nutrition-related challenges,
including those caused by an increased risk of cancer recur-
rence or the development of a second cancer, cardiovascu-
lar disease (CVD), or other chronic diseases. Many experience
long-lasting side effects of the cancer or its treatment or they
develop late effects that begin months or years after initial
treatment. According to the National Cancer Institute, individu-
als are considered cancer survivors from the time of diagnosis
through the balance of their lives.
This continuing education course focuses on cancer
survivors nutrition-related issues following the conclusion
of active cancer treatment. It reviews current diet, weight,
and physical activity recommendations for cancer survivors.
Nutrition-related challenges and questions survivors face
after cancer treatment also are discussed, including how to
support long-term health.
Recommendations for Survivors
Research on how nutrition, physical activity, and body com-
position affect cancer recurrence, the development of second
primary cancers, and overall survival for cancer survivors
still is limited. Nonetheless, evidence has accumulated that
supports recommendations to enhance recovery and promote
long-term health and quality of life. Among US survivors,
approximately 50% had breast, prostate, or colorectal cancer,
1

so these groups have been most widely studied. The attention
to breast cancer survivors in this review reects the availabil-
ity of applicable research ndings.
American Institute for Cancer Research (AICR) recommenda-
tions state that after treatment, if possible and unless otherwise
advised, survivors should aim to follow the organizations cancer
prevention recommendations for diet, physical activity, and
healthy weight maintenance.
4,5
As part of the Continuous Update
Project, in which the AICR partners with the World Cancer
Research Fund, systematic review and evidence-based recom-
mendations for breast cancer survivors are in progress.
The American Cancer Society (ACS) issued guidelines on
nutrition and physical activity specic to cancer survivors in
2012. The guidelines address survivors in general, although the
journal article in which the guidelines are presented discusses
issues unique to specic types of cancer.
6

An American College of Sports Medicine roundtable of
experts developed exercise guidelines for cancer survivors,
published in 2010.
7
Based on these guidelines, survivors are
encouraged to follow the federal physical activity guidelines for
all Americans, though in some cases certain modications are
necessary. All survivors are advised to avoid inactivity.
Sources providing more background on these recommen-
dations and patient education materials to explain them are
CPE MONTHLY
COURSE CREDIT: 2 CPEUs
LEARNING OBJECTIVES
After completing this continuing education course,
nutrition professionals should be better able to:
1. Use current evidence-based diet, weight, and physical
activity recommendations for cancer survivors to
prioritize goals for their nutritional care.
2. Evaluate how changes in body fat and lean body mass
may affect cancer survivors prognosis and how these
changes may be addressed.
3. Use current research to address questions cancer
survivors commonly pose regarding supplements
and dietary choices said to be cancer protective.
Suggested CDR Learning Codes
3020, 4040, 5150; Level 2
provided in the resources list created as a companion to this
article and available in the version of this article posted on the
Todays Dietitian website.
Protective Eating Pattern
Vegetables, fruits, whole grains, and legumes form the core
of a diet that reduces the risk of cancer and heart disease. Plant
foods that arent highly processed or rened provide a wide
range of nutrients and phytochemicals that may act protec-
tively throughout cancer development, inuencing DNA repair,
inammation, cell proliferation, and cancer progression.
4
Diets
built around foods low in calorie density are recommended to
avoid weight gain and support intentional weight loss.
4,8

However, neither observational nor interventional studies
have demonstrated a strong link between vegetable and fruit
consumption and reduced cancer recurrence or mortality.
6
The
effects of a diet high in vegetables and fruits likely are inuenced
by personal characteristics such as hormonal status, genetics,
gut microbiota, and medical treatment as well as how the diet is
implemented, including the choice and preparation of vegetables
and fruits, total calorie intake, and overall diet and lifestyle qual-
ity.
9-11
Studies examining the associations of vegetable and fruit
consumption with health outcomes generally adjust for BMI,
thus addressing benets beyond a role in weight management.
The Womens Healthy Eating & Living Study of early-stage
breast cancer survivors found no difference in breast cancer
recurrence or death between a control group and an inter-
vention group eating a low-fat diet very high in vegetables
and fruits.
12
Within the control group, neither the consump-
tion of ve vegetables and fruits daily nor moderate physical
activity alone was associated with lower mortality. However,
compared with women who met neither standard, those who
met both dietary and activity standards experienced almost
50% lower mortality.
13

A link between higher dietary fat intake and cancer risk once
suggested by observational data hasnt held up with closer
study,
4
and associations with breast cancer outcomes generally
disappear when results are adjusted for calorie intake, weight,
or weight change.
14,15

Limited studies on this topic among men diagnosed with
prostate cancer show inconsistent results. Dietary recommen-
dations from the AICR and the ACS dont address fat consump-
tion except to call for avoiding very high levels that contribute
to obesity.
4,6
The ACS recommends limiting saturated fat for
heart health, noting limited data linking saturated fat with
cancer risk or recurrence.
6
The strongest evidence from observational studies regarding
diet relates to the overall dietary patterns of cancer survivors.
Among those with stage III colorectal cancer, a more Western
diet, characterized by a high intake of meat, fat, rened grains,
and desserts, has been linked with more than double the overall
mortality and a nearly threefold increase in cancer recurrence
or death.
16
Among breast cancer survivors, no link to breast
cancer mortality or recurrence was seen, but those with the
highest Western or unhealthful diet scores had more than two
or three times the mortality from other causes than those with
lowest scores.
17,18
In the Nurses Health Study cohort, the major-
ity of these other deaths were due to other cancers or CVD.
17
Although a Western diet is associated with worse
outcomes among colorectal cancer survivors, a prudent
diet, characterized by a high intake of fruits, vegetables,
poultry, and sh, hasnt been linked to better cancer-specic
outcomes or overall mortality.
16

Among breast cancer survivors, higher scores for a healthy
dietary pattern are inconsistent in association with lower breast
cancer recurrence or mortality but are associated with a 28%
to 46% reduction in other causes of mortality, which includes
deaths from other cancers, CVD, and additional causes.
17-19

Among a cohort of older female survivors of all cancer types,
compared with lower scores, the highest scores for adherence
to the dietary portion of the AICR recommendations to reduce
cancer risk werent associated with decreased cancer mortality
but were associated with 20% lower all-cause mortality.
20
Weight and Body Composition
Traditionally, nutritional care for cancer survivors has
focused on preventing and treating malnutrition and on
regaining lost weight, and that remains true for some of them.
However, many survivors today are overweight or obese at
the time of their diagnosis and remain so following treatment.
This reects both the increased prevalence of obesity and its
association with cancer risk and improvements in treatment
and early diagnosis reducing unplanned weight loss.
Mounting evidence indicates that among cancer survivors,
prediagnosis obesity increases the risk of cancer recurrence,
cancer mortality, and all-cause mortality. These associations
are most strongly documented for breast cancer,
21-23
though
overweight and obesity also are associated with a worse
prognosis for colorectal and prostate cancer survivors.
24-29

Obesity doesnt increase the risk of prostate cancer, but higher
BMI and adult weight gain increase the risk of aggressive forms
of prostate cancer and related mortality.
30

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Obesitys link to poor prognosis for cancer patients may
relate to several mechanisms, including increased inamma-
tion and elevated levels of insulin and growth factors such as
IGF-1 that promote cancer cell growth.
24,31,32
Excess body fat
increases adipose production of estrogen in postmenopausal
women, raising levels that promote the growth of estrogen-
sensitive cancers. Obesity also is associated with the risk
of developing CVD, the primary cause of death among many
cancer survivors.
People at a healthy weight when theyre diagnosed with
cancer may gain weight during treatment and in the years that
follow. Fatigue, depression, and insomnia can lead to decreased
physical activity or increased calorie intake from using food
to cope with these problems, which can result in weight gain.
Some chemotherapy, hormone, and steroid medications also
can cause undesirable weight gain.
One analysis showed that about 35% of breast cancer
survivors experienced a 5% or larger weight gain two years
after diagnosis.
33
Yet in a review with a longer time horizon,
about 70% gained weight during and after treatment, including
those whose weight was stable during treatment.
34
Weight
gain now averages 8 to 10 lbs, which is less than in decades
past, but larger gains arent unusual. Weight gain is linked
with increased mortality from breast cancer, CVD, and all
causes.
33,35
Researchers generally conclude that avoiding
weight gain is an appropriate evidence-based goal for all
breast cancer survivors.
33,35
Research is less clear about the value of promoting weight
loss in cancer survivors. One study has linked modest weight loss
by breast cancer survivors with reduced cancer recurrence,
14

while another trial of breast cancer survivors showed that weight
loss of 5% or more decreased insulin and bioavailable estrogen
levels.
36
Several studies have linked elevated insulin, insulin
resistance, the metabolic syndrome, and abdominal obesity to
more aggressive breast cancers and a greater risk of recurrence
and death in breast cancer survivors.
37,38

The ACS guidelines for cancer survivors encourage
those who are overweight to achieve and maintain a healthy
weight, if only for noncancer health benets.
6
Despite many
reasons for overweight or obese cancer survivors to expect
benets from weight loss, little documentation of outcomes
is available. An analysis of four prospective cohort studies of
breast cancer survivors showed the lowest mortality rates
in those who maintained a steady weight in the rst few
years following their diagnosis.
33
Although breast cancer
mortality wasnt affected by weight gain or loss of 10% or
more, overall mortality increased, apparently related to
heart attack and stroke.
33

Its important for the health care team, including RDs, to
differentiate between unintentional weight loss caused by
deteriorating health or malnutrition vs. intentional, gradual
weight loss. In the pooled analysis of breast cancer survivors,
increased mortality among overweight and obese subjects
with a 10% or greater weight loss was limited to those with
a history of smoking and occurred primarily in those with
other chronic diseases. The study authors hypothesized that
increased mortality was related to substantial loss of lean
body mass, which is associated with negative cancer and
cardiovascular outcomes.
33

While RDs await the outcomes of more than two dozen
intentional weight-loss intervention studies in cancer
survivors now under way, they need to consider overall
health and prognosis when assessing the weight and
body composition of individual cancer survivors. Evidence
supports advising cancer survivors to avoid undesirable
weight gain.
4,6
For those already overweight or obese,
adopting healthful lifestyle habits to facilitate intentional
weight loss after treatment may be a worthwhile goal, if not
medically contraindicated and if efforts are made to retain
or improve lean body mass through a gradual rate of weight
loss and the inclusion of physical activity.
5,6,39
Evidence
suggests that benecial effects on important biomarkers,
such as insulin level, insulin resistance, markers of
inammation, and bioavailable estrogen, can be achieved
with weight loss of 5% to 10%.
6,40

Physical Activity
Survivorship care has changed dramatically in its empha-
sis on physical activity. The strongest evidence involves breast
cancer survivors, including several observational studies that
link greater postdiagnosis physical activity with reduced all-
cause mortality.
41
Most studies nd that, compared with less
activity, moderate exercise such as brisk walking for 2.5 to
six hours per week is linked with 25% to 50% reduced breast
cancer mortality and possibly decreased recurrence.
41-43

Physical activity also is associated with increased progres-
sion-free survival and reduced recurrence, cancer mortality,
and all-cause mortality in colorectal and prostate cancer
survivors.
41,44-46
Among survivors of all types of cancer in the
Iowa Womens Health Study cohort, adherence to the AICRs
physical activity recommendation was tied to lower all-cause,
CVD, and cancer mortality.
20
Interventions promoting physical activity consistently
have demonstrated improved tness, strength, and quality
of life and decreased fatigue and sleep disturbances
among survivors of various cancer types.
47,48
An analysis
of six interventional trials showed that early-stage cancer
survivors who werent assigned to exercise experienced
decreased tness levels, while those in supervised exercise
programs following treatment experienced improvements.
49

Interventional trials of breast cancer survivors have
demonstrated increased lean body mass, decreased body fat,
and reduced levels of insulin and IGF-1.
50-52
This is important
since elevated insulin levels are linked to cell proliferation
and cancer risk as well as the metabolic syndrome and
cardiovascular risk.
An American College of Sports Medicine roundtable con-
cluded that although physical activitys effects on mortality and
cancer recurrence are unclear, cancer survivors still should be
advised to avoid inactivity since strong evidence supports benets
to functioning and quality of life.
7
Its within RDs scope of practice
to discuss with patients general steps to increase physical activ-
ity if theyre medically cleared to exercise.
53
Referral to a certied
cancer exercise trainer for detailed plans also can prove helpful.
Exercise goals and plans need to be tailored to each cancer
survivor.
54
Some survivors face issues that require modify-
ing the type or amount of exercise thats safe for them, such as
anemia, compromised immune function, neuropathy, balance
problems, an ostomy or indwelling catheter, cardiac comor-
bidities, the presence of or risk factors for lymphedema, bone
metastases, and decreased bone density as a result of hor-
monal treatments.
6,7,54

Common Challenges
Loss of Weight and Lean Body Mass
Those who have survived cancers of the head, neck, and
lung are among those more likely to be malnourished and
underweight when diagnosed and at risk of further weight loss.
Loss of weight and lean body mass may result from disease,
aggressive treatment, and side effects that limit patients ability
to consume adequate calories. For these cancer survivors,
nutrition care should aim for positive energy balance and
adequate protein to preserve or rebuild lean body mass.
Physical activity also is important to increase strength and
endurance and, when tailored to individual needs, may help
improve eating by enhancing appetite.
Weight alone doesnt adequately reect changes in lean body
mass, which can dramatically decrease with aging and during
cancer treatment. Low lean body mass, especially as part of
sarcopenic obesity, is associated with poor health outcomes.
55-57

Androgen deprivation therapy for prostate cancer promotes
sarcopenic obesity. In one meta-analysis, body fat increased by
an average of 7.7% and lean body mass decreased an average
of 2.8% in conjunction with this therapy.
58

Loss of lean body mass often is also seen in survivors of
colon, breast, and childhood cancers. In the Health, Eating,
Activity & Lifestyle Study of breast cancer survivors, sarcope-
nia was associated with an almost threefold increase in overall
mortality independent of treatment type, comorbidities, waist
circumference, and total body fat.
59

Physical activity, including resistance training, may help
protect against the loss of lean body mass.
60
More research is
needed to clarify the optimal diet to support lean body mass
among cancer survivors. Adequate protein and calories are
essential, and research is under way regarding the potential
for omega-3 fatty acids to help reduce muscle catabolism and
the appropriate choices among protein sources to support
muscle growth.
61-63
Fatigue
Among the most common and debilitating problems
cancer survivors face, cancer-related fatigue is a persistent
tiredness not proportional to recent activity that interferes
with usual functioning and isnt alleviated with rest. Some
survivors experience this fatigue even years after treatment
is completed. Although it may appear without a clear cause,
cancer-related fatigue can occur because of new or ongoing
and potentially treatable medical problems such as thyroid,
pulmonary, cardiac, or liver disorders; anemia; depression;
poor appetite; and medications. Survivors are urged to discuss
fatigue with their physicians.
Family members and friends often urge survivors with can-
cer-related fatigue to rest more. While adequate sleep and rest
are important, research strongly supports engaging in physi-
cal activity to reduce cancer-related fatigue, and its one of the
few evidence-based treatments currently available.
64-66
Other
research shows that additional, potentially helpful nonpharma-
ceutical interventions include yoga, cognitive behavioral ther-
apy, counseling, and relaxation techniques.
Nutrition consultation also is included in National Compre-
hensive Cancer Network clinical practice guidelines for assess-
ing and addressing cancer-related fatigue.
67
The guidelines
highlight the management of nutritional deciencies that devel-
oped during cancer treatment, adequate hydration, and electro-
lyte balance to prevent and treat fatigue.
Few published trials have tested nutrition interventions for
cancer-related fatigue, though. Dietary adjustments beyond
those in the National Comprehensive Cancer Network guide-
lines that also may help include consuming ve or six mini
meals, distributing calories evenly through the day, or consum-
ing larger amounts of calories earlier in the day. Education is
vital to reinforce that mini meals arent snacks but nutritionally
balanced meals that provide complex carbohydrates, a small
amount of heart-healthy fat, and a protein source.
Although research is lacking, anecdotal data from dietitians
working with cancer survivors suggest that high-ber, whole-
food carbohydrate choices distributed throughout the day can
help survivors maintain their energy level and avoid fatigue
related to blood sugar swings. These data also are consistent
with guidelines to promote overall health.
Other Posttreatment Challenges
Cancer survivors typically recover from the acute effects of
their treatment within weeks or months after treatment ends.
In some cases, however, side effects of treatment persist, such
as taste changes, odynophagia (painful swallowing), dysphagia
(difculty swallowing), xerostomia (dry mouth caused by a lack
of saliva), enteritis, diarrhea, constipation, and other concerns
that can challenge nutritional status. The websites of the
National Cancer Institute (www.cancer.gov), the ACS (www.
cancer.org), the AICR (www.aicr.org), the American Society of
Clinical Oncology (www.cancer.net), and the Oncology Nutrition
Dietetic Practice Group of the Academy of Nutrition and
Dietetics (www.oncologynutrition.org/erfc) provide practical
tips for handling such problems. In addition, dietitians who
are board-certied oncology nutrition specialists (those with
the CSO credential) have special expertise in this area and are
excellent resources.
Questions About Supplement Use
Supplements are more widely used among cancer
survivors than by the general public.
68,69
However, currently
theres no consistent evidence indicating that dietary
supplements reduce the risk of cancer recurrence or
improve a persons odds of survival.
4,6
Nevertheless,
supplements can help reduce nutrient inadequacies, though
research is identifying U-shaped curves for an increasing
number of nutrients, meaning that inadequacy and excess
both may pose risks. The risks vary depending on the
nutrient but may include increased risk of various cancer
types, diabetes, and all-cause mortality.
Emerging data suggest certain supplements may help sur-
vivors deal with the side effects of cancer or its treatment.
Research in this area is ongoing, though, and updated informa-
tion is accessible through online sources such as those in the
accompanying resources list (available in the version of this
article on the Todays Dietitian website).
Multivitamin/mineral supplements often have been
recommended for cancer patients following treatment as
nutritional insurance. Data now suggest that these
supplements can help achieve adequate nutrient intake in
survivors whose diets are limited but dont offer support for
improving cancer outcomes or preventing mortality.
6,70-72

Some observational evidence raises concerns that high
levels of multivitamins may accelerate prostate cancer
progression and increase fatality.
72,73

The following are some supplements of particular interest
for cancer survivors:
Vitamin D seems to have antiproliferative effects that may
be especially benecial for decreasing cancer progression and
enhancing survival, at least based on animal studies.
72,74
Low
circulating 25-hydroxy vitamin D [25(OH)D], the recommended
biomarker of vitamin D status, is linked to an increased risk of
several cancers.
72,74
Observational studies tie higher 25(OH)D
levels to improved outcomes among colorectal cancer survi-
vors
75
and possibly breast cancer survivors.
76,77
But even when
low circulating 25(OH)D is associated with worse outcomes in
observational studies, it isnt clear whether supplementation
changes prognosis.
72,78

Its unclear whether the Institute of Medicines 25(OH)D
recommendation of 600 to 800 IU daily based on bone health
are adequate for bone or overall health among cancer
survivors. Some researchers propose targeting serum
25(OH)D levels of at least 30 ng/mL or 40 to 80 ng/mL in the
survivor population, with an intake of 1,000 to 2,000 IU of
vitamin D commonly recommended to reach those levels but
still not established as optimal.
72,74

Especially a concern among breast and prostate cancer
survivors is the risk of osteoporosis secondary to surgical,
chemotherapy, or hormonal therapies that decrease estrogen
or testosterone levels, respectively, or following long-term
corticosteroid use.
79,80
While aiming for bone- and cancer-
protective benets, researchers emphasize that evidence is
lacking regarding the safety of high blood levels of vitamin D.
Glutamine is an essential amino acid of interest for its
potential to aid mouth sores and other symptoms of mucosi-
tis and to improve peripheral neuropathy that develops as a
side effect of chemotherapy.
74
It supports gastrointestinal cell
growth and regeneration, and it may reduce the production of
inammatory cytokines. Signicant side effects are uncommon
with oral glutamine supplementation. More research on its use
is needed, but caution is advised among patients with hepatic
or renal insufciency because, since its an amino acid, the liver
and kidneys must metabolize glutamine. In patients with liver
or renal insufciency on protein restriction, glutamine supple-
mentation should be avoided so as not to burden these organs.
Glutamine is used in clinical practice as a powder mixed into
oral solution, generally swished before swallowing for muco-
sitis benet.
Melatonin, a hormone secreted by the pineal gland, holds
dual interest for cancer survivors. For those who have difculty
falling asleep, doses of 0.5 to 3 mg at bedtime may be help-
ful.
74,81
Emerging evidence suggests that melatonin may provide
cancer-protective effects by upregulating antioxidant enzymes
and suppressing factors that promote cancer development.
Limited data show some improvement in mortality rates when
used at higher doses as an accompaniment to conventional
cancer therapy.
74,81,82

Since melatonin can alter estrogen levels and may interact
with drugs metabolized through certain pathways, those con-
sidering use should consult their physicians.
81

Moving Into Survivorship Living
Survivorship in the Big Picture
Even after successful cancer treatment, some cancer cells
may persist and ultimately develop into a detectable cancer
recurrence. Cancer survivors also face a modestly increased
risk of developing a second primary cancer independent of
the rst, though for some cancers that risk is roughly double.
1

Increased risk of second primary cancers reects several
factors, including late effects of radiation or other cancer
treatments, genetic susceptibility, and lifestyle risk factors
(eg, tobacco, excessive alcohol intake, obesity, inactivity).
83

Although cancer survivors may worry most about cancer
recurrence, for some of the most common cancers, heart
disease is the predominant cause of death. This reects shared
risk factors and cardiotoxic effects of certain chemotherapies
and radiation cancer treatments, which may begin immediately
or many years later.
84,85
Most common is heart muscle damage
causing heart failure, but ischemia, hypertension, arrhythmias,
and other cardiac events also may occur. Cardiovascular
deconditioning and weight gain, common during some cancer
treatments and often not reversed later, also elevate risk.
Therefore, as cancer survivors move beyond treatment,
research supports health professionals in encouraging sur-
vivors to create lifestyles that help them maintain long-term
health, including steps aimed to decrease the risk of recurrent
or new cancers and the risk of heart disease.
Addressing Common Questions
Is soy safe for breast cancer survivors? The classica-
tion of soys isoavone compounds as phytoestrogens often
raises questions about soy and breast cancer risk, espe-
cially for women who had estrogen receptorpositive cancer.
However, animal studies suggesting such a risk dont accu-
rately represent human metabolism of isoavones. Multiple
population studies now have concluded that among estro-
gen receptorpositive breast cancer survivors (with or without
tamoxifen use), theres either no effect, a decreased recur-
rence, or decreased deaths related to moderate soyfood
consumption.
86-91

Observational studies have reported a modestly lower risk
of breast cancer in women who consume moderate amounts
of soy starting early in life, and moderate consumption does
appear safe for survivors.
6
A moderate amount is considered
to be one to two standard servings of soyfoods daily (eg,
1
2
cup of tofu or edamame or 1 cup of soymilk as one serving).
The safety of amounts above three servings daily is unclear,
and evidence isnt available regarding the effects of isoa-
vone supplements.
Does sugar feed cancer? All the cells in the body
use sugar for fuel, and cancer cells seem to take up blood
sugar more rapidly than do healthy cells. However, dietary
sugar, other carbohydrate, and gluconeogenesis from
protein all produce blood sugar. Both the AICR and the ACS
have concluded that the current evidence is too sparse and
inconsistent to support a link between sugar intake and
the risk or progression of cancer.
4,6
Hyperinsulinemia may
promote cancer cell growth, though.
92

For cancer protection, research supports maintaining healthy
blood sugar and insulin levels with weight control, regular
exercise, a high-ber diet, and avoiding large loads of rened
carbohydrate. Limiting foods and beverages high in added
sugar is recommended, but thats because of their general lack
of nutrients and substantial calorie load that promotes weight
gain, which is linked with worse cancer outcomes.
Is an alkaline diet cancer protective? Survivors may ask
about claims that an acidic body pH promotes cancer cell
growth, while an alkaline environment is protective. However,
no solid research supports such claims.
93,94

Theres no single measure of so-called body pH. Food
choices may affect urine pH, though research isnt consis-
tent on that. Intricate body systems maintain pH within a rela-
tively narrow range. The alkaline diet is plant based, so it does
offer protective nutrients, phytochemicals, and ber. However,
it imposes unfounded restrictions, discouraging not only pro-
cessed foods, white sugar, white our, caffeine, and meat but
also sh, poultry, and dairy products.
Optimizing Survivorship Care
The Institute of Medicine identies four essential compo-
nents of cancer survivorship care and recommends that every
cancer patient receive an individualized survivorship care plan
for monitoring and maintaining health.
95
A growing number of cancer treatment centers and hospi-
tals are establishing survivorship programs. Sometimes called
cancer prehabilitation (pretreatment care) and rehabilitation
programs, these may include pain management, smoking ces-
sation, exercise, and nutrition components.
96
Programs often
offer support groups and cognitive-behavioral therapy target-
ing stress management, relaxation training, and coping skills.
For a successful survivorship program, all stakeholders
should participate in planning, which should be based on evi-
dence-based effectiveness, program sustainability, and identi-
ed outcomes for program evaluation.
97

The Bottom Line
Cancer survivors stand to benet in many ways from a
healthful lifestyle. Unfortunately, for some, a cancer diagno-
sis doesnt always lead to health-protective changes.
20,98,99
In a
cross-sectional study of adult cancer survivors, most did meet
the recommendation to avoid smoking, but only 30% to 47% met
the physical activity recommendation, and about 15% to 19%
met the ve-a-day minimum vegetable and fruit target.
98

Dietitians play a vital role in enhancing cancer survivors
health and quality of life. Assessing survivors nutritional
status and dietary intake can identify areas in which theyre
nutritionally lacking and also areas of potential excess.
Guidance can help survivors meet nutritional needs and
improve outcomes relevant to cancer, cardiovascular, and bone
health. Survivors have wide-ranging needs for help in evaluating
information from many sources and making evidence-based
behavior changes that support recovery and long-term health,
and dietitians can assist them in addressing these needs.
Karen Collins, MS, RDN, CDN, FAND, is a speaker, writer,
and consultant who serves as the nutrition advisor for
the American Institute for Cancer Research.
For references, resources, and a patient handout view this
article on our website at www.TodaysDietitian.com.
CPE Monthly Examination
1. Approximately what percentage of Americans diagnosed with cancer
currently live more than ve years?
a. 25
b. 45
c. 65
d. 85
2. Based on recommendations from the American Institute for Cancer
Research (AICR) and the American Cancer Society (ACS) regarding physi-
cal activity, cancer survivors should do which of the following?
a. Talk with their physicians or a tness professional trained to work with
cancer survivors about how to safely incorporate strength training to
restore or minimize the loss of lean body mass.
b. Attempt to return to the level of exercise in which they engaged before
their cancer diagnosis, since cancer treatment doesnt affect the choice
of physical activity upon completion.
c. Engage in gentle exercise such as walking, but avoid strength training
because of cardiac and lymphedema risks.
d. Engage in physical activity every day or nearly every day, though it will
likely improve only sleep patterns and quality of life.
3. What does current research say about overweight and obesity in
cancer survivors?
a. Among cancer survivors today, overweight and obesity are more
common than underweight.
b. Most people who were obese when diagnosed with cancer are normal
weight or underweight by the time they complete treatment.
c. Prediagnosis obesity is associated with a greater risk of cancer but is
unrelated to cancer outcomes.
d. Research hasnt identied any mechanisms connecting obesity with
cancer outcomes, so any link seen likely is due to a mutual association
with lifestyle habits.
4. Which of the following statements best describes the issue of lean body
mass loss for cancer survivors?
a. Loss of lean body mass occurs as a later stage of excess weight loss.
b. Loss of lean body mass primarily is seen in association with mouth,
esophageal, and lung cancers.
c. Loss of lean body mass frequently is seen in survivors of colon, breast,
and childhood cancers.
d. Androgen deprivation therapy generally protects against the loss of
lean body mass often seen in prostate cancer.
5. What advice for overweight or obese cancer survivors is best sup-
ported by overall current research?
a. Aim for modest weight loss through changes in eating and physical
activity after conrming with your health care provider that you have no
medical contraindications, including low lean body mass.
b. Since cancer survivors have an increased risk of developing a second
cancer and heart disease, both of which increase with obesity, shed
excess weight as soon as possible.
c. Especially if theres excess weight around the abdomen, aim for at least
a 10% weight loss by reducing calorie intake, but dont chance the cardio-
vascular risk of increased physical activity.
d. Avoid weight gain, but dont attempt to lose weight because mortality
data suggest doing so poses signicant risk.
6. Evidence-based dietary recommendations suggest that cancer survi-
vors should do which of the following?
a. Focus on plant foods providing nutrients and compounds that can
inuence DNA repair, inammation, cell proliferation, and cancer
progression.
b. Aim for no more than 20% of calories from fat.
c. Include red meat at least once per day to provide bioavailable iron that
can thwart survivors tendency to develop anemia.
d. Exclude rened grains and all forms of sugar from their diet so as not
to promote the growth of any remaining micrometastases.
7. Which of these statements about cancer survivors soyfood consump-
tion is best supported by current research?
a. Women who start consuming soyfoods after a breast cancer diagnosis
can reduce the risk of recurrence.
b. Consuming one or two standard servings of soyfoods daily appears
safe for cancer survivors.
c. Daily soyfood consumption is safe for most cancer survivors, but those
who had estrogen receptorpositive breast cancers should avoid it.
d. Soyfoods contain phytoestrogens called isoavones that increase the
risk of breast, uterine, and prostate cancers.
8. Which of the following statements about vitamin D and cancer survi-
vors is best supported by current evidence?
a. Laboratory studies show that vitamin D may play a role in slowing down
the early stages of cancer development, but its unlikely to affect pro-
gression or survival.
b. Observational studies have linked higher vitamin D status with better
outcomes in colorectal cancer survivors and possibly breast cancer
survivors.
c. Current evidence shows a straight-line relationship in which the
higher cancer survivors blood levels of vitamin D, the lower their risk of
mortality.
d. Because of an increased need for vitamin D among cancer survivors,
an intake of 5,000 IU/day now is recommended for survivors unless there
are medical contraindications.
9. When working with cancer survivors who suffer from cancer-related
fatigue, RDs should do which of the following?
a. Encourage them to rest more and cut back on activities.
b. Suggest saving the majority of their calorie intake for evenings, when
theres more time and energy to prepare a balanced meal.
c. Help them plan mini meals that provide high-ber carbohydrate, pro-
tein, and healthful fat yet require minimal energy for preparation.
d. Suggest they consult a psychologist or mental health counselor since
the fatigue likely reects depression.
10. Which of the following best meets published recommendations for
cancer survivorship programs?
a. Activities begin either as soon as treatment ends or in later months
when a survivor feels ready.
b. Each survivor is plugged into one of a few generic survivorship care
templates that meet the needs of most survivors.
c. Programs focus mostly on decreasing risk of cancer recurrence, since
for most survivors that poses the greatest threat to quality of life and
mortality.
d. Dietitians play a vital role in helping survivors improve outcomes
related to cancer, cardiovascular, and bone health.
For more information, call our continuing education division toll-free at
877-925-CELL (2355) M-F 9 AM to 5 PM ET or e-mail CE@gvpub.com.
Register or log in on CE.TodaysDietitian.com
to purchase access to complete the online
exam and earn your credit certicate for
2 CPEUs on our CE Learning Library.
PERSONAL COMPUTING
FACEBOOK, WHERE TO?
By Reid Goldsborough
Facebook, the worlds largest social networking site,
recently celebrated its 10
th
anniversary, which calls for a look
backward and forward.
Founded in 2004 by Mark Zuckerberg and four of his Har-
vard University classmates, Facebook initially was limited to
Harvard students before rst expanding to other colleges in
the Boston area then other Ivy League colleges followed by
other colleges, high schools, and anyone in the world who
claims to be at least 13 years old.
Today, Facebook contends it has more than 1 billion active
users, about one-seventh of the worlds population, though
this number likely is exaggerated. Still, Facebooks reach is
undeniable, as Zuckerbergs goal is to connect the world.
Part of his recently announced 10-year plan is helping users
answer interesting questions or solve problems.
People use Facebook to keep up with news about
friends and family, write public and private messages, post
photographs and videos, nd people from their past, and join
common-interest groups organized by workplace, school,
hobby, or other characteristics.
Myspace (at the time stylized as MySpace) was the rst
widely popular social networking site, launched in 2003 just six
months before Facebook. It took Facebook until 2008 to over-
take Myspace in popularity.
Over the years, Facebook has received its share of
criticismand it still does. It changes its interface too often for
many users, forcing them to learn new ways to use it. It has a
loosey-goosey approach to privacy, collecting data on users and
bombarding them with ads. Despite
the criticism, Facebooks advertising
revenue has grown exponentially.
But if youre not careful, as with
several other online activities, you
can get scammed or otherwise
harmed through Facebook. One
scam involves Facebooks Like
option, its thumbs-up button. Likes
can generate ad revenue for the
business or individual behind the
particular Facebook page. Any
attempt to sell users Likes is a
scam, and Facebooks policies
prohibit this practice. According to
Facebooks help system, Certain
websites promise to provide large
numbers of likes for your Page if
you sign up and give them money.
These websites typically use
deceptive practices or are scams.
Another scam involves a You gotta see this! or simi-
lar message. When you click on it, youre asked through a
pop-up window to download a media player. Only the down-
load is malware that steals your data, identity, or money. The
Facebook section of Hoax-Slayer (www.hoax-slayer.com/
facebook-related.html) has more detailed information about
Facebook-related scams and hoaxes.
Facebook isnt the only current social networking site,
though. The most prominent competing services include
Twitter, Google+, and LinkedIn.
Twitter specializes in letting you send and read tweets,
which are text messages of up to 140 characters. You can
update your followers with news ranging from your recent job
promotion or upcoming marriage to your thoughts about the
movie you just saw or what you had for dinner.
Google+ attempts to leverage Googles other services,
from search and online storage to e-mail and cloud software.
LinkedIn is targeted for professional networking, helping
companies and business people make new contacts and keep
in touch with previous coworkers, afliates, and clients.
The social media world is constantly in ux. In February,
Twitter began testing an experimental interface with a select
group of users thats a cross between Facebook and Google+.
Today, Facebook is arguably the second most prominent
online presence, behind Googles search engine. In the ever-
changing online world, its an open question whether this
will remain the case.
Reid Goldsborough is a syndicated columnist and author of
the book Straight Talk About the Information Superhighway. He can
be reached at reidgoldsborough@gmail.com or reidgold.com.
FOCUS ON FITNESS
WEIRD WORKOUTS
Fun Activities Way Beyond the Conventional
By Jennifer Van Pelt, MA
Over the course of my 25 years teaching tness classes and
writing about tness, Ive seen many tness fads come and
go. Within the last few years, Ive noticed a new overall fad: the
increasing number of weird workouts.
We all have different perceptions of what weird is, and what
may be weird for some may be normal for others. For example,
many exercisers think workouts performed at 4:30 AM are weird
because they prefer exercising at a different time. Exercise
previously considered weird may evolve into a normal and
popular activity. For instance, in the 1970s, only hippies did
yoga, but now millions of Americans practice different styles of
yoga every day.
The workouts discussed here recently have been
deemed weird by major tness organizations, popular
health magazines and websites, and/or social media.
Most are available only in urban areas with large gyms
or at specialized facilities, such as health resorts, sports
training centers, and boutique tness studios. For each
weird workout, Ive provided a brief description, the potential
benets or disadvantages, and the types of clients who
may nd it appealing. Ive also commented on whether a
particular weird workout may evolve into a popular and
widespread tness activity in the future, such as yoga did.
Indulge Your Inner Child
Hula hooping: This workout uses a standard or weighted
hula hoop to perform various movements designed to tone the
hips, thighs, and abdominal muscles. Hoopnotica, a branded
hula hoop workout, recently has emerged, offering instructor
certications and DVDs. According to WebMD, hula hooping can
burn as many calories as a step aerobics or boot camp class
and is a viable workout option.
1

Benets: Calorie burning and toning in a fun workout.
Downside: The workout could become frustrating, and the
movements may not be suitable for those with hip or knee joint
issues or low back pain.
Hula hooping may appeal to clients who want to exercise
with their children or who are looking for a fun alternative to
core conditioning classes.
Circus workouts: Offered at large gyms and special
circus training centers, these workouts involve learning about
and using the trapeze and acrobatic equipment used by circus
performers. Trapeze workouts are available on high trapezes
with a safety net or very low stationary trapezes in a room.
Inspired by Cirque de Soleil, companies specializing in
circus tness for adults and children have emerged, primarily
in major cities such as New York, Philadelphia, and Atlanta. In
fact, Reebok and Cirque de Soleil recently partnered to create
Jukari Fit to Fly, a trapeze class that uses a special bar that
can be afxed to a gyms tness classroom ceiling. Some yoga
studios now are offering aerial or oating yoga. Yoga poses are
performed in silk hammocks suspended from the ceiling. The
silks resemble those used by many acrobatic circus performers.
Benets: Strength and exibility.
Downside: Expensive and limited access.
Trapeze workouts will appeal to clients who want a challenge
and anyone who ever dreamed of joining the circus when they
were younger. Aerial yoga may interest those looking for a new
yoga challenge.
Trampolining: Small trampolines known as rebounders
or mini-trampolines hit the market in the late 1970s and 1980s.
Occasionally, tness infomercials for rebounders still can be
seen on TV and online. I have one of my own, and I nd that the
bouncy surface is easy on the joints. Rebounding has been pro-
posed as benecial for the immune system because its sup-
posed to help with lymphatic drainage.
2
No studies have been
published on this proposed benet, but two recent studies
reported signicant benets for stroke rehabilitation and fall
prevention for the elderly.
3,4

Due to the popularity of larger trampolines for home yards,
trampoline tness centers recently have been built in some areas.
Fitness classes for adults, children, and families are offered.
Benets: Cardiovascular and toning without the impact of
exercise on hard surfaces.
Downside: Larger trampolines have the potential for spinal
injuries due to improper landing.
Clients looking for a fun home exercise alternative thats
easier on the joints than a treadmill should investigate the inex-
pensive mini-trampoline. DVDs are available for home workout
guidance. Families looking for a fun exercise alternative should
check out local trampoline tness centers, but they should
make sure that all bouncing is supervised.
Release Your Inner Rock Star
Karaoke cycling: Add a microphone and karaoke machine
to an indoor cycling room and let the party begin. Crunch Fit-
ness gyms offer this workout that mixes traditional faster
cycling music with slower karaoke song favorites. Participants
can opt whether to sing while cycling.
Benets: Cardio benets of cycling combined with some
fun. Being able to sing karaoke does allow participants to judge
their level of exertion; they will know theyve recovered from the
hard cycling interval that left them gasping for air.
Downside: How many individuals are comfortable singing in
front of others? And, in my experience, cycling classes are well
attended because of the variety of music. Do they really want
to hear the person next to them, who may or may not have any
vocal talent, singing a Maroon 5 song when they can hear the
original in a standard cycling class?
Punk rock aerobics: Originating in Boston about 15 years
ago, punk rock aerobics classes were held during the day in
rock clubs, often with guest DJs supplying punk rock classics
from groups such as the Ramones. These classes appeal to
anyone who dislikes the conventional gym setting. According
to major news magazines such as Rolling Stone and Newsweek,
the punk rock workout attracts anarchists under age 30 and
older rockers looking to get in shape and enjoy wearing what-
ever they want. According to its website, Punk Rock Aerobics
is about empowerment, stating, We aim to inspire, empower,
and have a good time. The company now offers rock camps
for young girls with the intention of building self-esteem and
improving tness.
Benets: Cardiovascular and strength conditioning to music
that rocks.
Downside: The music wont appeal to everyone, and access
currently is limited to areas where the company offers classes.
Clients of any age who like punk rock music and prefer to
wear knee socks and funky shorts, rather than designer yoga
pants, may nd this workout appealing.
Drumming workout: Drumming-based workouts use
drumsticks and upper body movements combined with other
aerobic movements to provide a cardiovascular workout that
focuses on upper body strength. In some classes, regular
drumsticks are used to drum on stability exercise balls.
A new branded workout called POUND uses proprietary
RipStix (lightly weighted drumsticks) and combinations of
cardio, Pilates, isometrics, and plyometrics in a 45-minute
class set to rock, rap, dubstep, and other music styles with
strong beats. Classes are offered at gyms listed on the web-
site (www.poundt.com/the-workout), and a DVD for home
exercise also is available.
Benets: Cardiovascular, core, and upper body conditioning
to fun music.
Downside: Drumsticks or RipStix must be purchased for
home use. Weighted drumsticks may aggravate shoulder joints.
Clients who want an alternative full-body workout set to
music will like this workout.
Adding Variety and Fun
The list of weird workouts is too long to include all of them
here. Some that I havent summarized but recommend avoiding
due to safety issues include the stiletto workout (working out in
high heels) and treadmill dancing, both of which have a high risk
of injury due to falling.
Of those I have summarized, I believe trampoline workouts
have the greatest potential for growth and longevity. Even
though numerous injuries associated with trampolining have
been reported, these have occurred mostly in children left
unsupervised on home backyard equipment. The introduc-
tion of trampoline sport centers offering supervised classes
or bouncing time will minimize the risk of injury. Trampolin-
ing became an Olympic sport in 2000, which has helped fuel
interest as well. Mini-trampolines are an inexpensive alter-
native to expensive home exercise equipment, and they carry
little risk of injury.
If you have clients who are bored with conventional tness
activities, suggest they investigate a safe weird workout to add
variety and fun to their exercise program.
Jennifer Van Pelt, MA, is a certied group tness instructor
and health care research analyst/consultant
in the Reading, Pennsylvania, area.
References
1. Goodman B. Hula hoop workouts burn calories.
WebMD website. http://www.webmd.com/tness-exercise/
news/20110210/hula-hoop-workouts-burn-calories. February
11, 2011.
2. Scrivens D. Rebounding: good for the lymph system.
WellBeing Journal website. http://www.wellbeingjournal.com/
rebounding-good-for-the-lymph-system.
3. Miklitsch C, Krewer C, Freivogel S, Steube D. Effects of a
predened mini-trampoline training programme on balance,
mobility and activities of daily living after stroke: a randomized
controlled pilot study. Clin Rehabil. 2013;27(10):939-947.
4. Arago FA, Karamanidis K, Vaz MA, Arampatzis A. Mini-
trampoline exercise related to mechanisms of dynamic stability
improves the ability to regain balance in elderly. J Electromyogr
Kinesiol. 2011;21(3):512-518.
GET TO KNOW
JOANNE SLAVIN
Conducting Research and Inspiring
the Next Generation of Nutrition Pioneers
By Juliann Schaeffer
As a professor at the University of Minnesota and a leading
nutrition researcher for the past three decades, Joanne Slavin,
PhD, RD, has published more than 200 scientic articles,
helped 55 graduate students discern their own food and nutri-
tion path, and likely inspired countless others who happened
upon her lecture classes in one way or another.
Writing hundreds of scientic articles doesnt happen without
being involved in several research studies. Whether its assist-
ing in a student research project on what causes heart disease
or directing her own study on how various types of ber affect
the body, Slavin knows her way around a research lab (and fecal
samples, as youll see later), though she didnt get to this place
without years of honing her nutrition knowledge base rst.
Growing up on a Wisconsin dairy farm, Slavin says 4-H was
an important aspect of life in her community, and she showed
an afnity for food and nutrition, especially baking, pretty early.
But I was actually more interested in sports and wanted to be a
gym teacher, she says. That changed when she gave a speech
about calories in college, and soon after she switched her edu-
cation focus to nutrition. She didnt know it then, but shed
spend the next decade as a studentand calories were just the
tip of what shed learn.
At the University of Wisconsin-Madison, Slavin earned not
just a bachelor of science degree but then an RD credential
followed by a masters degree and doctorate, all with a focus
in nutritional sciences. After all that time spent in a class-
room, one may think Slavin would grow tired of that environ-
ment but not so, she says. Though various speaking and other
engagements take her away for a time, to this day her home
base continues to be a college classroom.
What led her to pursue this path? According to Slavin, she
had way too much fun learning to ever contemplate leaving
the university life. Living in Madison and hanging out with
other graduate students was much more fun than working
for a living, so it was an easy choice to continue in graduate
school, she says. I decided that university professors had
about the best job I had ever heard about, so I wanted to be
able to work at a university.
Though her doctorate may have afforded her some great
professional opportunities, she says its her RD credential that
has proved the most valuable. I always used my RD skills, she
says, whether in making wedding cakes, working in foodser-
vice, or giving talks on sports nutrition. I always tell my stu-
dents that I would give up my PhD before my RD, since my RD
has helped me pay the rent my entire working life.

Todays Dietitian (TD): What do you enjoy most about your job?
Slavin: Working with students. Food and nutrition is an amaz-
ing eld with so many routes to a successful life. Some of my
best students ever have decided to be full-time parents, a place
where their amazing skills can have a huge impact.

TD: You worked on the Dietary Guidelines Advisory Committee
(DGAC). What input did you have in crafting the 2010 version of
the guidelines, and how did those guidelines come to be?
Slavin: I was honored to be a member of the 2010 DGAC. The
DGAC is the scientic support for the guidelines. I chaired the
carbohydrate and protein committees and also worked on the
energy balance and nutrient adequacy subcommittees. After
the scientic report is issued, the government writes the
Dietary Guidelines for Americans. The DGAC doesnt see the
guidelines before theyre released to the public, so if you have
any complaints about the Dietary Guidelines for Americans,
please send them up the government channels.
TD: In what ways do you think the 2010 Dietary Guidelines
improved on the previous version?
Slavin: Im particularly proud that protein was added to the
guidelines. The role of whole foods such as vegetables, whole
grains, fruits, and dairy products also was a strength of the
Dietary Guidelines for Americans.
TD: Were there any downsides about the process or any 2010
guidelines you wish you could modify or change completely?
Slavin: Because of such a broad scope, its difcult to cover
all the topics of interest to Americans. Usual topics such as
fat, sugar, and salt never go away, but new topics emerge (eg,
gluten, prebiotics, GMOs). Its hard to cover all these issues with
an evidence-based approach.
TD: How have your personal experiences changed or molded
your outlook on life and on eating?
Slavin: Ive traveled a lot and seen that other cultures take
more care in eating and appreciate the importance of eating
in life. I worked in Switzerland, and every day it was required
that you check out for one hour for lunch. The lunch was
shared with your coworkers, and great conversations were
part of those lunches. [Here in the United States,] weve lost
the connection with food and family that I had as a child grow-
ing up on the farm.
TD: If you could offer clients only one piece of advice, what
would it be?
Slavin: Make peace with your diet; dont obsess about grams of
added sugar or solid fat. Its counterproductive to health.
TD: What has been the most exciting or signicant nding
youve uncovered in your research thus far in your career?
Slavin: That all bers are different. Choose psyllium or wheat
bran if you want a larger stool, and go with oat bran or guar
gum if you want to lower serum lipids.
TD: Whats the most exciting research that youre working
on right now, either one that has come out recently or is
still ongoing?
Slavin: Like everyone else on the planet, were interested in
changes in microbiota with different diets, except unlike every-
one else on the planet, we were interested in this area long
before it became cool.
TD: Do you have any favorite stories from your research
studies that have stuck with you?
Slavin: Since we collect fecal samples for a living, most of my
favorite stories would be in the potty humor area, including
cases of stolen fecal samples.
TD: What has been the biggest professional obstacle youve
faced, and how did you overcome it?
Slavin: I didnt get a dietetic internship. I later found out that
my advisor never got around to sending off any of the letters I
needed. So I did a traineeship after earning my MS to get the
experiences needed to sit for the RD exam. Its quite likely that
if I had gotten an internship, I would be working as a dietitian
in southern Wisconsin and would never have gone to graduate
school and become a professor.
TD: What foods do you crave?
Slavin: Bacon, ice cream, and fresh baked bread with butter.
TD: Whats one food with an unhealthful stigma thats actually
pretty good for people?
Slavin: Potatoes: Theyre high in vitamin C, potassium, ber,
and high-quality protein.
TD: Conversely, whats one food that gets a good rap
but shouldnt?
Slavin: Fruit: It generally only contains carbohydrate and not
that much ber. Many consumers dont understand that fruit
contains no protein.
TD: Whats the biggest step people can take today to decrease
their risk of diet-related disease in the future?
Slavin: Enjoy life and understand that fat doesnt cause heart
disease. Dietary patterns are linked to disease outcomes, but
eating dinner as a family and enjoying food are more important
than obsessing about every gram of fat or milligram of sodium.
Consumers feel cheated when they develop colon cancer, for
example, even when they have been on a high-ber diet their
entire lives.
Physical activity is likely more important than diet in the
prevention of diseases such as heart disease, cancer, and
diabetes. But routine physical activitywalking the dog,
gardening, and playing softball with friendsis the type of
physical activity we need everyone to enjoy; theres no need to
run marathons or join expensive gyms.
TD: What food or exercise items are on your bucket list?
Slavin: My bucket list is all checked off. I never let an opportu-
nity pass me by, a lesson I learned from my mom.
TD: Whats something most people may be surprised to learn
about you?
Slavin: I play a mean accordion, so call me if you need some
polka background music at your next event.
Juliann Schaeffer is a freelance writer and editor based in
Alburtis, Pennsylvania, and a regular contributor to Todays Dietitian.
Physical activity is likely more
important than diet in the prevention
of diseases such as heart disease,
cancer, and diabetes. But routine
physical activity is the type of physical
activity we need everyone to enjoy;
theres no need to run marathons or
join expensive gyms.
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Potassium Supplements May Increase
Survival in Patients Taking Diuretics
Researchers from the Perelman School of Medicine at the University
of Pennsylvania found that patients taking prescription potassium
supplements together with loop diuretics for heart failure have better
survival rates than patients taking diuretics without potassium. Moreover,
the degree of benet increases with higher diuretic doses. The team,
including senior author Sean Hennessy, PharmD, PhD, an associate
professor of epidemiology in Penns Center for Clinical Epidemiology and
Biostatistics, reported its ndings in a study published online in PLOS ONE.
Loop diuretics, which are one type of diuretic or water pill named after
the part of the kidney acted on, are commonly used in the treatment of heart
failure (and associated lower-limb edema or swelling) to help push out extra
uid that can accumulate when the heart isnt working properly. However,
they also ush out needed potassium, causing many physicians to prescribe
potassium supplements. But its survival benet has never been studied,
and because of this lack of evidence, theres controversy about whether
potassium should be prescribed to all patients receiving loop diuretics.
In a retrospective study, the researchers examined existing health
care data from Medicaid between 1999 and 2007 to study approximately
180,000 new starters of loop diuretics who were prescribed supplemental
potassium and an equal number of people who started a loop diuretic
without the potassium supplement. The researchers found that in patients
receiving at least 40 mg/day of furosemide (one form of loop diuretic),
adding supplemental potassium appeared to reduce mortality by 16%, a
large and statistically signicant reduction.
Our ndings provide evidence that adding potassium supplementation
may increase survival rates among patients taking loop diuretics, says the
studys lead author, Charles E. Leonard, PharmD, MSCE, a senior research
investigator in the Center for Clinical Epidemiology and Biostatistics and the
senior manager of the Ambulatory Drug Use & Effects Program at Penn.
Nonetheless, because this is the rst such study of this question, we hope
that others conrm these results in independent studies.
The researchers also found that in patients receiving less than 40 mg/day
of furosemide, potassium appeared to reduce the mortality rate by 7%, a
suggestive but statistically nonsignicant nding. (The overall mortality rate
was about 9% per year in the population under examination.)
The use of potassium supplementation under investigation was preventive
as opposed to being prescribed to patients who already had measured
reductions in potassium. Only patients receiving supplemental potassium in
solid (not liquid) form were studied, the latter possibly indicating an inability
to swallow and therefore a marker for a possibly complicating corollary
medical impairment.
These results appear to support the common practice of using potas-
sium together with loop diuretics. Today, nearly 5.8 million Americans
suffer from heart failure.
Using potassium supplementation for patients receiving loop diuretic
therapy may be a relatively inexpensive way to save lives, Hennessy says.
In todays climate of seeking cost-effective measures to keep patients
healthy, this is a therapy that certainly merits additional consideration.
SOURCE: PERELMAN SCHOOL OF MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA
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NEWS BITES
Quality, More Than Quantity,
Matters in Exercise, Diet
If the goal is losing weight and maintaining optimal health
and tness, the quality of the exercise and diet regimen mat-
ters more than the quantity, says Paul Arciero, DPE, a pro-
fessor in the health and exercise sciences department at
Skidmore College in Saratoga Springs, New York.
In a paper published by The Journal of Applied Physiology,
Arciero and several colleagues reported the clear benets of
a multidimensional exercise regimen that includes resistance
exercise, interval sprint exercise, stretching (including yoga
or pilates), and endurance exercise. If people add moderate
amounts of protein regularly throughout the day, theyll be on
their way to decreasing total and abdominal fat, increasing
lean body mass, and achieving optimal levels for blood
pressure, blood glucose, and insulin.
A member of the advisory board of the American Heart
Association and a fellow of both the American College of
Sports Medicine and the Obesity Society, Arciero is familiar
with the exercise and diet recommendations issued by these
and other governing health organizations. Theyre well
intended, but theyre complex, and theyre not being com-
municated in a way thats easy for the public to understand
and incorporate in their daily life-
style, he says. I wanted to test an
exercise protocol with a nutritional
component thats simple and under-
standable for people.
To conduct the study, Arciero
enlisted 36 female and 21 male
volunteers between the ages of 35
and 57 who could be described as
out of shape. They exercised fewer
than 60 minutes per week, had done
no resistance training within the last
10 years, and could be described as
obese or overweight, with an average
BMI of 28.6 and average body fat
percentage of 36.6.
Dividing his subjects randomly
into three groups, Arciero conducted
a 16-week trial in which all subjects
consumed the same amount of whey
protein (60 g/day) but exercised dif-
ferently. One group was sedentary,
another performed intense resistance
training four times per week, and the
third followed a multidimensional
regimen that included resistance
exercise, interval sprint exercise,
stretching led by a yoga instructor,
and endurance exercise.
When the trial ended, Arciero found that those who had
followed the multidimensional regimen showed the greatest
health improvements, including the greatest reductions in
body weight, total and abdominal fat mass, waist circumfer-
ence, and blood glucose. In addition, this group experienced
the greatest increase in percentage of lean body mass.
Interestingly, all groups showed improvements, even those
who maintained a sedentary lifestyle during the period and
simply ate the assigned daily regimen of 60 g of whey protein.
That nding supports an earlier study by Arcieros team that
found increasing the amount of protein in the diet to as much
as 35% may decrease total and abdominal fat.
Overall, the study supports a rethinking of current
assumptions about exercise, which Arciero believes place
too much focus on the quantity of exercise people do rather
than the quality of that exercise. Its very difcult to just lift
weights or only do the treadmill or the elliptical machine
and be healthy, he says. Your exercise regimen needs to
encompass as much of what makes you a fully integrated
living person as possible.
Its not about simply doing more exercise, he continues.
Its about doing the appropriate range of exercises and
activities that most effectively promote health and tness.
SOURCE: SKIDMORE COLLEGE
Poor Health, Lifestyle Factors Linked to Memory Complaints
If youre depressed, dont get enough exercise, or have
high blood pressure, you may nd yourself complaining
more about memory problems, even if youre a young
adult, according to a new UCLA study.
UCLA researchers and the Gallup organization polled
more than 18,000 people about their memory and a vari-
ety of lifestyle and health factors previously shown to
increase the risk of Alzheimers disease and dementia.
They found that many of these risk factors increased the
likelihood of self-perceived memory complaints across
all adult age groups. The ndings, published in PLOS
ONE, may help scientists better
identify how early lifestyle
and health choices impact
memory later in life. Examin-
ing these potential relation-
ships, researchers say, also
could help to pinpoint inter-
ventions aimed at lowering the
risk of memory issues.
The 18,552 individuals
polled ranged in age from 18
to 99. The known risk factors
the researchers focused on
included depression, lower
education levels, physical
inactivity, high blood pressure,
diabetes, obesity, and smoking.
They were surprised by the
prevalence of memory issues
among younger adults, says the studys senior author
Gary Small, MD, UCLAs ParlowSolomon Professor on
Aging and director of the UCLA Longevity Center. In this
study, for the rst time, we determined these risk factors
may also be indicative of early memory complaints,
which are often precursors to more signicant memory
decline later in life, says Small, who also is a professor
of psychiatry and biobehavioral sciences at the Semel
Institute for Neuroscience and Human Behavior at UCLA.
Depression, low levels of education, physical inactiv-
ity, and high blood pressure increased the likelihood of
memory complaints in younger adults (ages 18 to 39), mid-
dle-aged adults (40 to 59), and older adults (60 to 99), the
researchers found. Depression was the strongest single
risk factor for memory complaints in all age groups.
Having just one risk factor signicantly increased the
frequency of memory complaints, regardless of age,
according to researchers. Memory complaints rose when
the number of risk factors increased.
Overall, 20% of those polled had memory complaints,
including 14% of younger adults, 22% of middle-aged
adults, and 26% of older adults.
The researchers noted that, in general, memory issues
in younger people may be different from those that plague
older individuals. For younger adults, stress may play
more of a role, and the ubiquity of technology, including
the Internet and wireless devices, which often can result
in constant multitasking, may impact their attention span,
making it harder to focus and remember.
Small notes that previous
studies have shown that edu-
cation is a key element of cog-
nitive reserve, the ability to
compensate for progressive
brain pathology. These results
suggest that pursuing educa-
tional activities at any stage of
life may be helpful.
We hope that our ndings
will raise awareness among
researchers, health care
providers, and the general
public about the importance
of lowering these risk factors
at any age, such as getting
screened and treated for
depression and high blood
pressure, exercising more,
and furthering ones education, says Stephen Chen,
MD, an associate clinical professor of psychiatry and
biobehavioral sciences at the Semel Institute and the rst
author of the study.
Were planning to use these results as a basis for
future studies to better understand how reducing these
risk factors may possibly lower the frequency of memory
complaints, says author Fernando Torres-Gil, PhD, a
professor at UCLAs Luskin School of Public Affairs and
the associate director of UCLAs Longevity Center.
The Gallup poll used in the study took place between
December 2011 and January 2012 and was part of the
GallupHealthways Well-Being Index, which includes
health- and lifestyle-related polling questions. Pollsters
conducted landline and cell phone interviews that cap-
tured a representative 90% of the US population, accord-
ing to the researchers.
SOURCE: UCLA HEALTH SCIENCES
Eat What You Love Everyday
By Marlene Koch
2014, Running Press
Hardcover, 352 pages, $26.50
With 200 new
recipes, Marlene
Koch offers plenty of
delicious options, all
modied with healthful
eating in mind.
The rst section
of the book contains
healthful eating tips,
an explanation of
ingredients used in
her recipes (I love that
she used everyday
ingredients for the
everyday cook), meal planning suggestions, and general
information for diabetes patients on how to use her book.
Kochs concept of eat what you love is right on target.
As dietitians, we know that sustaining healthful eating habits
requires good-tasting food. Kochs recipes make that task
easy, and she often does dare to compare so consumers
can compare the nutrition facts of a familiar dish with her
modication.
The books food photography is exquisite, which likely will
motivate readers to try her recipes. I decided to try the Oven
Fried Mozzarella Sticks With Marinara Sauce. This recipe
caught my interest because the item is frequently ordered
in restaurants or purchased from the freezer section of the
grocery store, but restaurant or store-bought fried cheese
sticks are loaded with fat, carbohydrates, and calories. Kochs
recipe contained only 3 g of carbohydrates, 4.5 g of fat, and 80
kcal for two pieces. The recipe turned out perfectly and was
a delicious comfort food. My only recommendation is to swap
out the garlic salt for garlic powder to help lower the sodium
level. People with diabetes, for example, need to limit their
sodium intake, and I thought this swap made sense with the
cheese being a higher-sodium food to start.
Throughout the book, there are strategies on cooking or
nutrition information worth mentioning, which are located
in the Marlene Says section. Kudos to Koch for adding
carbohydrate choice as part of the nutrition information for
each recipe, one of the many ways she speaks directly to
diabetes patients in this book.
One of the last sections of the book, Menus for Every
Day, Every Occasion, and Everyone, is helpful for the
average consumer. This section offers a little extra help
to put together delicious, nutritious menus and provides
different menu options by combining delectable recipes
from the book.
I have a confession to make. As someone who manages
type 1 diabetes, I was captivated some time ago by Kochs
90 Calorie Chocolate Cupcakes from a previous book. Now
Im staring at the photo of her Molten Chocolate Lava Cakes,
weighing in at only 21 g of carbohydrates. I love this book and
Kochs recipes, but in fairness, I must acknowledge that I
may be under the inuence of chocolate.
Toby Smithson, MSNW, RDN, LDN, CDE, is a spokesperson
for the Academy of Nutrition and Dietetics and the author of
Diabetes Meal Planning and Nutrition for Dummies.
Fresh From the Farm: A Year of Recipes and Stories
By Susie Middleton
2014, Taunton Press
Hardcover, 256 pages, $28
Author Susie Middletons fantasy became reality when she
started her own full-working farm shortly after leaving her
job as editor-in-chief of Fine Cooking magazine. Fresh From
the Farm captures Middletons experience in her rural world
growing vegetables, raising chickens, and enjoying the fruits
of her labor.
The book not only
includes 125 delicious
recipes but also tells a
story of how a farmer
came to be. Middletons
captivating stories of
life on the farm, woven
through the pages of
her delicious recipes,
truly give the reader a
sense of escape and
an appreciation for
the simpler life. Its
BOOKSHELF
accompanying photos take the reader on a journey from the
farm to the prepared meals on the dinner table.
Divided into three categories by growing seasonsLate
Spring and Early Summer, High Summer, and Indian Summer
and Early Fallthis is a book focused on fresh, simple dishes
both cooks and aspiring gardeners or farmers can learn from.
I particularly like Middletons focus on basic food preparation
tips for fruits and vegetables, such as those showcased in her
recipes for Slow-Roasted Beefsteak Tomatoes and Roasted
Carrot Fries With Roadhouse Dipping Sauce.
Interjections of Cooks Tips throughout the book offer
additional advice for novice to experienced cooks, ranging
from tips for properly preparing wheat berries to serving
perfectly warm French toast to shelling fava beans. The
appendix offers advice for individuals aspiring to start their
own garden market or simply wanting to try their hand at a
small-scale backyard farm.
The Roasted Butternut Squash Risotto With Thyme,
Parmigiano and Toasted Pine Nuts was a personal favorite
recipe, as was the one for the Chocolate-Chocolate Chip
Zucchini and Raspberry Mufns; they were among the best
mufns/cupcakes Ive ever made, and I had multiple friends
and family members begging for the recipe.
This certainly is a book that both RDs and food lovers can
embrace, as it showcases healthful, nutrient-rich foods in
all their glory. Middletons approachable style welcomes the
reader in and shows them how delicious simple foods grown
straight from the land truly can be.
McKenzie Hall, RD, is a cofounder of Nourish RDs, a nutrition
communications and consulting business based in Los Angeles.
Whole-Grain Mornings:
New Breakfast Recipes to Span the Seasons
By Megan Gordon
2014, Ten Speed Press
Hardcover, 184 pages, $22
Finding time in the morning to make a breakfast complete
with whole grains and natural, seasonal foods can be a chal-
lenge, and you may nd yourself reaching for prepared cere-
als or other fast but not-so-healthful choices.
Megan Gordon aims to help you start your day right with a
collection of 65 wholesome and innovative breakfast recipes.
Seasonal recipes,
such as Greens and
Grains Scramble
and Strawberry
Rhubarb Quick Jam,
complement breakfast
staples such as Whole-
Grain Pancake Mix and
The Very Best Oatmeal.
The book begins
with a peek inside
Gordons cupboard.
Stocking up on some
basics, such as certain
spices, herbs, oils, and
natural sweeteners,
will be helpful in making Gordons recipes. She also provides
an overview of whole grain ours plus how to store and cook
them. Packed with ber, protein, and amino acids, whole grains
provide ample energy and keep you feeling fuller longer.
Each chapter features a Seasonal Spotlight on different
fruits and veggies. Youll get tips on how to select, store,
and prepare them. Make It Your Own recipe suggestions
encourage both novice and experienced chefs to get creative
in the kitchen.
Keep in mind that while some of the recipes may be fairly
easy and quick to make, you may have to plan ahead and pur-
chase some of the ingredients or even refrigerate prepared
ingredients overnight. Helpful Make Ahead tips easily will
guide you with this. Cooking times may be longer than you can
allot on a busy morning as well. However, Gordon is careful to
include how to properly store your creations in the fridge or
freezer and how long they will last.
The book, which features many colorful, mouth-watering
photos, goes beyond the kitchen, too. Gordon delightfully
shares her personal journey of successfully founding a busi-
nessMarge Granolaand relocating from San Francisco to
Seattle to be with a newfound love.
So whether youre making it fresh or youre grabbing it on
the go from the fridge, make your mornings nourishing with
these tried-and-true recipes. Clients seeking nourishing
breakfast ideas are sure to enjoy them, too.
Karen Appold is a freelance medical writer and editor
based in Pennsylvanias Lehigh Valley.
PRODUCTS + SERVICES
Real McCoys Rice Chips and
Puffs Bear Whole Grains Stamp
Real McCoys Snacks offers a line
of all-natural, gluten-free rice chips
and puffs made with whole grain,
non-GMO ingredients.
Handcrafted with organic whole
grain kernels of brown rice, these snacks are free of trans
fats and bear the Whole Grains Stamp of approval from the
Whole Grains Council.
Real McCoys Rice Chip avors include Sweet & Spicy, Worces-
ter & Chives, and Sea Salt. Real McCoys Rice Puffs avors include
Vermont White Cheddar, Jalapeo Cheddar, and Hatch Chile.
For more information, visit http://realmccoysnax.com.
Primal Essence Releases Teas,
Coconut Oil Products
Primal Essence, an organic and natural extracts producer,
is showcasing its own brand of certied organic, all-natural
Organic Super Teas and Infused Coconut Oils.
In Classic Chai, Ginger Zing, Lemon Ginger, Peppermint Splash,
Turmeric Tulsi, and Vanilla Chai varieties, Primal Essences
Organic Super Teas come in 45-mL pump bottles that are loaded
with natural phytonutrients and antioxidants. With just two or
three squirts, the teas can be used in water, juice, and coffee.
With just a spoonful of Infused Coconut Oil, which comes in
Garlic Onion, Indian Curry, Italian Herb, Lemon Pepper, Smoked
Chili, and Thai Curry varieties, dishes exude natural avors from
whole-food extracts with all the benets of coconut oil.
For more information, visit www.primalessence.com.
PowerICE Debuts New
Flavors of Frozen Bars
PowerICE has announced that its frozen hydration
bars, designed to enhance performance in athletes
by cooling the core body temperature while
replenishing lost electrolytes, are now made with
100% all-natural ingredients.
The company also has doubled the number of
avors in its lineup, introducing Pomegranate
Raspberry Rip and Grape Score to accompany
original avors Lime Kicker and Orange Blast.
For more information, visit www.powerice.com.
GloryBee Adds New
Raw Honey Varieties
GloryBee, a family-owned and -operated provider of
all-natural honey, sweeteners, spices, dried fruits, nuts,
and oils, has rolled out ve new raw honey avors: Raw
California Orange Blossom, Raw Mountain Wildower,
Raw Organic Tropical Blossom, Raw Pacic Northwest
Clover, and Raw Pacic Northwest Raspberry.
GloryBees new honey avors are raw, meaning the
honey hasnt been heated above 115F, pasteurized, or
processed in any way, allowing the honey to retain a
more creamy texture. Raw honey contains bee pollen,
vitamins, enzymes, antioxidants, and other important
natural nutrients.
For more information, visit http://glorybee.com.
Xlear Introduces
Spry Gems Mints
Xlear (pronounced clear) has developed a new line
of mints called Spry Gems. Consuming too much sugar
can lead to various dental issues, including damage to
the teeth, gums, and oral tissues. Spry Gems give candy
lovers the best of both worlds by delivering treats that
taste great and promote good oral health.
Available in Peppermint, Berry, Spearmint, and
Cinnamon avors, Spry Gems contain xylitol, a natural
sweetener, and are formulated with all-natural
ingredients. In addition, their pH-balanced formula helps
protect and preserve oral health, and Spry Gems provide
calcium for increased tooth enamel remineralization.
For more information, visit www.xlear.com.
Pitcher Filters Water
at the Speed of Your Faucet
CamelBak has introduced Relay, the rst water ltration
pitcher to lter water at the speed of your faucet. It relies on
a unique, pleated double-lter technology system that lters
water twice, once as the pitcher is lled
and again as water is poured. The Relay
Fresh Filter lasts for four months with
regular usage. Independent test results
have shown Relay removes 97% of
chlorine, taste, and odor.
Now available nationwide, CamelBak
Relay is BPA-free and dishwasher safe.
For more information, visit www.camelbak.com.
Bump Water Packs in Folic
Acid for Pregnant Women
Developed by two moms who saw a need for a
prenatal vitamin-infused water, Bump Water is a
functional, all-natural beverage designed to ensure
women get enough folic acid to help their developing
baby. Bump Water contains 100% of the Recommended
Dietary Allowance of folic acid; vitamins A, D, B
6
, and
B
12
; niacin; biotin; zinc; and magnesium.
Bump Water comes in four avors, including
Sparkling Lemonade and Sparkling Cranberry Ginger.
For more information, visit www.bumpwater.com.
Corazonas Expands Line of
Heart-Healthy Oatmeal Squares
Corazonas Foods, maker of snacks infused with choles-
terol-lowering plant sterols, has added Chocolate Coconut
Macaroon and Orange Cranberry Oatmeal Squares to its line
of heart-healthy snacks.
The bars join the brands classic Oatmeal Squares lineup,
which includes seven different options, from Peanut Butter
and Blueberry to Chocolate Brownie & Almonds. Like the
existing avors, the new bars have 15 to 16 g of whole grain
oats, 6 g of protein, and 5 g of ber with no trans fat. Theyre
the only bars proven to lower LDL cholesterol and have no
wheat, our, or high-fructose corn syrup. Each bar is made
with oats, apple juiceinfused fruits, and fruit pure.
For more information, visit http://corazonas.com.
KIND Releases
Savory Snack Line
KIND Healthy Snacks has released STRONG & KIND,
the brands rst savory snack line. STRONG & KIND has
10 g of natural protein (soy- and whey-free) from ingre-
dients such as whole almonds, seeds, and legumes that,
when combined, pack all nine essential amino acids.
The new line features ve avors: Honey Smoked BBQ,
Honey Mustard, Roasted Jalapeo, Hickory Smoked,
and Thai Sweet Chili.
As with other KIND products, STRONG & KIND
is gluten-free, non-GMO, low sodium, and contains
no MSG.
For more information, visit www.kindsnacks.com.
Seapoint Farms Adds Dry
Roasted Black Edamame Snack
Seapoint Farms is debuting its new snack: Dry Roasted
Premium Black Edamame With Sea Salt.
Black edamame is made from a unique variety of black soy-
bean thats distinctly sweet and prized in Japan. Its high in
nutritional value due to the levels of omega-3 fatty acids, iron,
vitamin K, and anthocyanins.
The product joins Seapoint Farms other black edamame
snack, Crunchy Coated Premium Black Edamame. Like all
of Seapoint Farms edamame, its gluten-free, heart healthy,
and non-GMO. It has 14 g of complete protein per serving, is a
good source of ber, is cholesterol-free, and has just 130 kcal
per serving.
For more information, visit www.seapointfarms.com.
Cluck n Moo Cuts the Fat,
Seals in the Flavor
Cluck n Moo Burger is a proprietary crafted blend
of humanely raised antibiotic- and hormone-free,
grass-fed beef and humanely raised antibiotic- and
hormone-free chicken. The hybrid burger is Certied
Gluten Free and has 52% less fat, 34% fewer calories,
and 57% less saturated fat than a typical grass-
fed beef burger. The companys Smashed Burger
production method allows the burgers to cook quickly
by sealing in the juices and keeping them moist.
For more information, visit http://clucknmoo.net.
Welchs New 100% Juice Line
Hits Stores Nationwide
Welchs brings the Farmers Pick line of 100% juices to the
juice aisle. Available in Concord Grape, Mango, and Blackberry
avors, Farmers Pick contains no preservatives, articial
avors, synthetic colors, or ingredients. Unlike most 100% fruit
juices in the shelf-stable juice aisle, Welchs new line contains
unltered juice.
In addition to using unltered juice,
Welchs uses cold-kettle batching to
bring the fresh-picked fruit avors of
Farmers Pick to life. When batching
the juice, Welchs keeps the kettles
cool to help preserve the delicate
avor and aroma of the fruits used to make the juice.
For more information, visit www.welchs.com.
RESEARCH BRIEFS
Study Conrms Diet
Beverages Aid Weight Loss
A new study published in Obesity conrms that drinking
diet beverages helps people lose weight.
This study clearly demonstrates that diet beverages can
in fact help people lose weight, directly countering myths in
recent years that suggest the opposite effect: weight gain,
says James O. Hill, PhD, executive director of the Univer-
sity of Colorado Anschutz Health and Wellness Center and a
study coauthor. In fact, those who drank diet beverages lost
more weight and reported feeling signicantly less hungry
than those who drank water alone. This reinforces that if
youre trying to shed pounds, you can enjoy diet beverages.
The 12-week clinical study of 303 participants is the rst
prospective, randomized clinical trial to directly compare the
effects of water and diet beverages on weight loss within a
behavioral weight-loss program. Conducted simultaneously by
researchers at the University of Colorado Anschutz Center for
Health and Wellness in Aurora and Temple Universitys Center
for Obesity Research and Education in Philadelphia, the study
shows that subjects who consumed diet beverages lost an
average of 13 lbs44% more than the control group, which lost
an average of 9 lbs.
More than one-half of the participants in the diet beverage
group (64%) lost at least 5% of their body weight, compared with
only 43% in the control group. Losing just 5% of body weight has
been shown to signicantly improve health, including lowering the
risk of heart disease, high blood pressure, and type 2 diabetes.
Theres so much misinformation about diet beverages
that isnt based on studies designed to test cause and effect,
especially on the Internet, says John C. Peters, PhD, a
study coauthor and the chief strategy ofcer of the Anschutz
Health and Wellness Center. This research allows dieters to
feel condent that low- and no-calorie sweetened beverages
can play an important and helpful role as part of an effective
and comprehensive weight loss strategy.
Study participants were randomly assigned to one of two
groups: those who were allowed to drink diet beverages, such
as diet sodas, teas, and avored waters, or those who were
in a control group that drank only water. With the exception of
beverage options, both groups followed an identical diet and
exercise program for the duration of the study.
In addition to losing 44% more weight than the control
group, the diet beverage group also reported feeling signi-
cantly less hungry, showed signicantly greater improve-
ments in serum levels of total and LDL cholesterol, and saw
a signicant reduction in serum triglycerides. Both diet soda
and water groups saw reductions in waist circumference and
blood pressure.
This latest study adds to the body of research demon-
strating that diet beverages dont hinder, but in fact help,
with weight loss. In particular, two studies published in the
American Journal of Clinical Nutrition in 2012 and 2013 by
researchers from the University of North Carolina randomly
assigned nondieting participants to drink either water or
diet beverages. While both groups cut their food intake sig-
nicantly, after six months, the diet beverage group had a
greater likelihood of reaching a meaningful (5%) amount of
weight loss compared with the control group. The diet
beverage group also experienced a greater reduction in
dessert consumption than the water group. Overall, the
ndings suggest that diet beverages dont fuel a preference
for sweet foods and drinks.
Additional research published in 2009 on weight-loss
maintenance, drawn from the National Weight Control
Registry, found that successful weight-loss maintainers
drank three times more diet beverages than those who had
never lost weight.
SOURCE: UNIVERSITY OF COLORADO DENVER ANSCHUTZ MEDICAL CAMPUS
This study clearly demonstrates
that diet beverages can in fact
help people lose weight, directly
countering myths in recent years
that suggest the opposite effect:
weight gain.
James O. Hill, PhD
Lewes, Delaware beebehealthcare.org
Part Time position to cover operational hours of
8am - 5pm, Monday-Friday. BSN required. State of
Delaware RN license or Compact State. Must have
current BLS through American Heart Association.
Provides individual and group education to persons
with Diabetes, their families, and appropriate support
systems about diabetes self-management and related
issues. Addresses educational needs of other health
care professionals who do not specialize in diabetes,
and the public. Performs basic foot and nail care to
individuals with diabetes. Administers diabetes health
management education to children, pregnant women,
adults, and elderly individuals within the Beebe
Medical Center inpatient or community populations.
PLEASE VISIT OUR WEBSITE FOR COMPLETE JOB DESCRIPTIONS
www.beebehealthcare.org
employment@beebehealthcare.org
Phone 302-645-3336
EOE | 424 Savannah Rd, Lewes, DE 19958
www.facebook.com/beebecareers
Beebe Healthcare, located in
Lewes, DE, ofers you a unique
Work/Life balance set in a beautiful,
tranquil setting with exceptional
leadership and an award winning
staf of professionals.
What do you want to Be?
RN-Certifed Diabetes Educator/
Diabetes Management - Part Time
Be Inspired
Are you looking for a patient-centered,
team-oriented work environment where
you will make a difference in patient lives?
Community Hospice has the position for
you where youll be able to practice in a truly
interdisciplinary supportive team environment.
Dietitian will perform the coordination of all
phases of diet therapy, including nutrition
assessment, nutrition care planning, patient
monitoring, and patient and family education.
Full time, part time, or per diem positions
available. Pay range is $32.00-$37.00/hr.
Qualied candidates must possess current
registration with the Commission on Dietetic
Registration and a B.S. in Nutrition, Dietetics,
or related eld.
To apply, please send rsum via e-mail:
hrdept@hospiceheart.org or apply online at
http://careers.hospiceheart.org/careers. EOE
Registered
Dietitian
www.hospiceheart.org
TD_CA_CommHospice.indd 1 7/18/14 5:19 PM
FT Experienced Dietitian needed to support community
health needs. Duties include outpatient & inpatient
diabetes and nutrition education with coverage of
inpatient care, including screening, assessment, and
nutrition support. Other duties may include coverage
to outreach clinics and community education events
as needed. RD required. Two years of experience
in a hospital clinical setting is required. CDE certification
required within 6 months of hire. Our 176-bed accredited
regional acute care medical center is located in a 60,000
rural population community at the base of the beautiful
Cascade Mts., all-season recreation, 280 days of
sunshine each year, and friendly atmosphere.
Competitive salary/benefits, including interview and
relocation assistance.
For more information about our facility/community
and to apply for this vacancy, visit our website at
www.skylakes.org.
SUCCESS
in Your Allied Health Search
The

KEY
to
Bakery On Main introduces 12 new ways to put a smile on those
gluten-free tastebuds: three as-good-for-you-as-they-taste avors
of Soft & Chewy bars packed with whole grains; six exotic avors of
Truebars, an honest-to-goodness line of fruit and nut bars that say
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ADVERTISER INDEX
For advertising information, please call 800-278-4400 or visit our website at
www.TodaysDietitian.com.
Alberta Barley Commission, http://gobarley.com ......................................... 15
Almased, www.almased.com ............................................................................ 9
Bakery On Main, www.bakeryonmain.com ..................................................... 63
CherryFlex, www.cherryex.com ................................................................... 65
Daisy Brand Cottage Cheese, www.daisybrand.com/cottagecheese ............. 4
Domino Foods, www.dominosugar.com/light
www.chsugar.com/light .................................................................................... 3
Hass Avocado Board, www.loveonetoday.com/hpresources .......................... 2
Merisant US Inc., www.equal.com .................................................................. 64
Merisant US Inc., www.purevia.com............................................................... 64
NASPGHAN, www.naspghan.org .................................................................... 35
Overeaters Anonymous, www.oa.org ............................................................. 13
Purity Foods, www.natureslegacyforlife.com................................................. 64
Rosalind Franklin, www.rosalindfranklin.edu/chp/nutrition.aspx ................. 64
TH Foods, www.thfoods.com .......................................................................... 27
Vitatech/Cinsulin, www.cinsulin.com ............................................................ 68
Wisdom/Sweetleaf, www.sweetleaf.com ....................................................... 67
This index is a service to our readers. The publisher assumes no liability for errors
or omissions.
D
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C
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Sponsored Content
Showcase
Summer
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SEPTEMBER 2-5, 2014
14
TH
INTERNATIONAL NUTRITION
& DIAGNOSTICS CONFERENCE
Prague, Czech Republic
www.indc.cz/en
SEPTEMBER 8-10, 2014
NATIONAL WIC ASSOCIATION
NUTRITION EDUCATION AND
BREASTFEEDING CONFERENCE
& EXHIBITS
Atlanta, Georgia
www.nwica.org
SEPTEMBER 12, 2014
COLORADO SOCIETY FOR PARENTERAL
AND ENTERAL NUTRITION 29
TH

ANNUAL NUTRITION SUPPORT
SYMPOSIUM
Aurora, Colorado
www.nutritioncare.org
SEPTEMBER 12, 2014
OKLAHOMA ACADEMY OF NUTRITION
AND DIETETICS FALL SYMPOSIUM
Edmond, Oklahoma
http://oknutrition.org
OCTOBER 11, 2014
AMERICAN DIABETES
ASSOCIATION DIABETES EXPO
Minneapolis, Minnesota
www.diabetes.org
OCTOBER 24, 2014
FOOD DAY
A nationwide celebration and
movement for healthful, affordable,
and sustainable food
www.foodday.org
OCTOBER 29-31, 2014
AMERICAN INSTITUTE FOR CANCER
RESEARCH ANNUAL RESEARCH
CONFERENCE ON FOOD, NUTRITION,
PHYSICAL ACTIVITY, AND CANCER
Washington, D.C.
www.aicr.org
NOVEMBER 5-6, 2014
IOWA ACADEMY OF NUTRITION
AND DIETETICS ANNUAL MEETING
West Des Moines, Iowa
www.eatrightiowa.org
NOVEMBER 8, 2014
AMERICAN DIABETES ASSOCIATION
DIABETES EXPO
Pittsburgh, Pennsylvania
www.diabetes.org
NOVEMBER 21, 2014
CHILDRENS HOSPITAL OF
PHILADELPHIA EMERGING TOPICS
IN PEDIATRIC NUTRITION:
A PRACTICAL APPROACH
Philadelphia, Pennsylvania
www.chop.edu/cme
NOVEMBER 22, 2014
AMERICAN DIABETES ASSOCIATION
DIABETES EXPO
Atlanta, Georgia, and Portland, Oregon
www.diabetes.org
DECEMBER 4-6, 2014
AMERICAN SOCIETY FOR NUTRITION
ADVANCES AND CONTROVERSIES IN
CLINICAL NUTRITION
Washington, D.C.
www.nutrition.org
MARKETPLACE DATEBOOK
BEGINNING AUGUST 1, 2014
REGISTRATION NOW OPEN
FOR THE 2014 RENFREW
CENTER FOUNDATION EATING
DISORDERS CONFERENCE FOR
PROFESSIONALS FEMINIST
RELATIONAL PERSPECTIVES
AND BEYOND: THE PRACTICE
OF PEOPLE
November 14-16, 2014
Philadelphia, Pennsylvania
Featuring specialized workshops
for dietitians and nutrition
therapists
17.5 continuing education credits
available
Contact: Debbie Lucker
Phone: 877-367-3383
E-mail: dlucker@renfrewcenter.com
www.renfrewconference.com
SEPTEMBER 26, 2014
ENHANCING HEALTH WITH
PLANT-BASED NUTRITION
PROFESSIONAL MEDICAL
CONFERENCE
Oregon Convention Center,
Oregon Ballroom
777 NE MLK Jr Blvd
Portland, Oregon
http://nwveg.org/health_
conference
Datebook listings are offered to all nonprot
organizations and associations for their
meetings. Paid listings are guaranteed
inclusion. All for-prot organizations are paid
listings. Call for rates and availability.
Call 610.948.9500
Fax 610.948.7202
E-mail TDeditor@gvpub.com
Send Write with your listing two months
before publication of issue.
SWEET CORN
Its Whats for Breakfast
By Grace Dickinson
As a child, I would have told you that corn should be eaten solely
on the cob. A quarter of its kernels should be smeared across your
face and hands, and if you were lucky, youd look like a Dalmatian pup
because of the char marks left on your face from the grilled kernels.
Some of my fondest summertime childhood memories stem
from corn on the cob. I remember helping my dad lug large buck-
ets of ice water up the grassy hill near our charcoal grill. Hed
soak the ears of corn then throw them on the hot grates, letting
me play basketball while they cooked. As the corncobs steamed
in their husks, Id either beg my dad to join me in a game of hoops
or ask him every two minutes how much longer did I have to wait
until dinner was ready. I was a typical impatient kid with an atypical
appetite for corn on the cob.
Inherently sweet, corn is the veggie version of candy, from the
kernels down to the sugary cob, on which I often found myself
chewing. At dinnertime, Id frequently eat ve cobs of corn served
alongside nothing else but a pat of butter and salt.
I cherish these childhood memories, but Im all grown up
now and would rather not have a bunch of kernels lodged in my
teeth and smeared across my face. Now I even conjure up ways
to go beyond single-ingredient meals and have a desire to use
corns sweetness to compliment other avors in a recipe. These
days, I nd myself using seasonal ingredients for inspiration to
create a complete meal.
The following breakfast taco recipe is a good example of this
and has become an annual summertime favorite. Keeping it rela-
tively simple, ber-lled corn teams up with buttery squash, a bit
of feta, and vine-ripened tomatoes. All the ingredients take corns
sweetness to another level, and with the help of a few uffy eggs,
this dish becomes a well-balanced meal.
For added avor, grill your corn ahead of time, and add it in with
the rst tomato. If youre like me, youll end up munching on a cob
for old times sake while you prepare the meal.
Grace Dickinson is a photo enthusiast, food blogger,
and recipe developer for FoodFitnessFreshAir.com.
CULINARY CORNER
Summer Squash and Corn Breakfast Tacos
These breakfast tacos are perfect for all meals.
If you dont have a gas stove, warm the tortillas
by placing them in a dry (no oil) stainless steel
skillet over medium heat for about 30 seconds
on each side.
Serves 4
Ingredients
2 T extra-virgin olive oil
1 medium white onion, diced
1 serrano pepper, minced
2 small summer yellow squash, julienned into
2-inch strips
2 ears of corn, kernels sliced from the cob
Salt and pepper, to taste
2 medium tomatoes, diced
6 large eggs
2 T milk
8 (6-inch) soft white corn tortillas
5 oz feta cheese, crumbled
1/2 cup cilantro, chopped
Hot sauce, optional
Directions
1. In a large saut pan, heat oil over medium-high
heat. Add onion and serrano pepper, and saut
for 2 minutes. Stir in yellow squash and corn, and
saut for another 3 minutes. Season with salt and
pepper. Add one tomato and continue to cook until
onion and squash are tender, stirring regularly,
about 5 minutes.
2. In a small bowl, whisk eggs with milk and a dash
of salt and pepper. Pour them into the pan with the
vegetable mixture. Cook, stirring occasionally, until
eggs are uffy and cooked through, 2 to 4 minutes.
3. Using tongs, place corn tortillas over a gas
ame for 30 seconds on each side to slightly char
the outside. Place on a plate and top each tortilla
with a spoonful of the egg mixture. Crumble feta
on top, and sprinkle with cilantro and the remain-
ing chopped tomato. Serve, with a side of hot
sauce, if desired.
Calories: 420; Total fat: 10 g; Sat fat: 4 g; Trans
fat: 0 g; Cholesterol: 300 mg; Sodium: 415 mg; Total
carbohydrate: 30 g; Dietary ber: 5 g; Sugar: 5 g;
Protein: 9 g
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*
N
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ie
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G
lu
t
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Diabetic-Friendly Skinny Shirataki

No Calories, Sugar, Carbs, Fat or Gluten.

Enhance the avor of your water, naturally and guilt free

Liquid Stevia Sweet

within the normal range

Das könnte Ihnen auch gefallen

Today&#39;s Dietitian - August 2014

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Verfügbare Formate

2014

Diabetic-Friendly Skinny Shirataki

No Calories, Sugar, Carbs, Fat or Gluten.

Enhance the avor of your water, naturally and guilt free

Liquid Stevia Sweet

within the normal range

Das könnte Ihnen auch gefallen

Today's Dietitian - August 2014

Today's Dietitian - August 2014